![]() ![]() It was confirmed that the protective effect of generalized and empirical PEEP on lung function was much lower than that of individualized PEEP. In the past clinical practice, the PEEP value was often set at 5–10 cmH 2O based on personal experience or according to the results of numerous studies applied to the optimal PEEP in non-obese patients. However, how to set up the ideal individualized PEEP for obese patients in laparoscopic surgery is still uncertain. In order to reduce the incidence of atelectasis, the PEEP level of obese patients should be much higher than that of non-obese patients. ![]() Especially in the general anesthesia of laparoscopic surgery, the formation of atelectasis caused by pneumoperitoneum and mechanical ventilation will be further aggravated, which will seriously affect the prognosis and outcome of obese patients. In obese patients, lung function is impaired due to the reduction of oxygen reserve, functional residual capacity, and lung compliance. However, how to set individualized PEEP remains a matter of debate. RM can reverse alveolar collapse but have limited benefit without sufficient PEEP. Among these lung-protective ventilation strategies, individualized PEEP is important to prevent processive alveolar collapse. ![]() In the expert consensus, the following was strongly recommended: preoperative pulmonary risk evaluation, an individualized mechanical ventilation which include a tidal volume ( V T) of 6–8 ml/kg predicted body weight (PBW), positive end-expiratory pressure (PEEP) of 5 cmH 2O, and alveolar recruitment maneuvers (RM). Recently, an international expert consensus recommendation about lung-protective ventilation for the surgical patient was reported. In recent years, more and more attention is paid to intraoperative mechanical ventilation strategies, which may affect PPCs in addition to the preoperative optimization of patients’ status and operation style. Considering that approximately 234 million patients worldwide require surgical treatment under general anesthesia each year, reducing the incidence of PPCs may have a great impact on global mobility and mortality. According to the type of surgery and the definition of PPCs, the incidence of PPCs has been reported to range from 5 to 33%. It is quite certain that postoperative pulmonary complications (PPCs) result in more morbidity and mortality, as well as prolong hospital stays. Secondary endpoints will be serum IL-6, TNF-α, procalcitonin (PCT) kinetics during and after surgery, incidence of PPCs, organ dysfunction, length of in-hospital stay, and hospital expense. Primary endpoints will be postoperative atelectasis measured by chest electrical impedance tomography (EIT) and intraoperative oxygen index. Standard lung-protective ventilation methods such as low tidal volumes (7 ml/kg, predicted body weight, PBW), a fraction of inspired oxygen ≥ 0.5, and recruitment maneuvers (RM) will be applied during and after operation in both groups. A PEEP of 5 cmH 2O will be used in PEEP5 group, whereas an individualized PEEP value determined by a Cstat-directed PEEP titration procedure will be applied in the iPEEP group. They will be randomly assigned to control group (PEEP5 group) and iPEEP group. A total number of 80 obese patients with body mass index ≥ 32.5 kg/m 2 scheduled for laparoscopic gastric volume reduction and at medium to high risk for PPCs will be enrolled. This study is a single-center, two-arm, prospective, randomized control trial. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. ![]()
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