In Reply We thank Borges et al for their insightful comments on our article.1 We are thrilled to see that our colleagues appreciate the relevance of mild postoperative pulmonary complications (PPCs). Understanding the development of perioperative atelectasis and other mild PPCs could help future efforts to minimize multihit perioperative lung injury. Indeed, our multicenter study findings suggest that PPCs are common and diverse in their presentation and severity and that even mild while frequent complications (eg, atelectasis) are associated with early postoperative mortality and hospital resource use.1 Thus, interventions to reduce any contributing hit should include efforts to reduce atelectasis, for example by optimizing lung distention with appropriate positive end-expiratory pressure management.
Fernandez-Bustamante A, Vidal Melo MF. The Increasing Call for Protective Ventilation During Anesthesia—Reply. JAMA Surg. 2017;152(9):894. doi:10.1001/jamasurg.2017.1615
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