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Comment & Response
November 12, 2019

Intraoperative Ventilation Strategies to Reduce Pulmonary Complications in Obese Patients—Reply

Marcelo Gama de Abreu, MD, MSc, PhD, DESA1; Marcus Schultz, MD, PhD2; Paolo Pelosi, MD, FERS3; et al on behalf of the Writing Committee for the PROBESE Collaborative Group
Author Affiliations
  • 1Department of Anesthesiology and Intensive Care Medicine, Technische Universität Dresden, Dresden, Germany
  • 2Department of Anesthesiology, University of Amsterdam, Amsterdam, the Netherlands
  • 3Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
JAMA. 2019;322(18):1829. doi:10.1001/jama.2019.14400

In Reply Dr Ferrando and colleagues raise a number of concerns about the PROBESE trial.1 General anesthesia induces atelectasis in the vast majority of patients (>90%), especially morbidly obese patients.2 The recruitment maneuver used in the study does not lack pathophysiological support. Atelectasis is reversible to different extents, depending on the level of pressure at end of inspiration and the time spent at that pressure.3 These factors were considered when defining the target inspiratory pressure of 40 to 50 cm H2O and the cumulative time (>9 seconds). Driving pressure increased over time in the low PEEP group, indicating that atelectasis did develop. Importantly, driving pressure was approximately 6 cm H2O lower in the high PEEP group, supporting the effectiveness of the recruitment maneuver.

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