Technology, Computing, and Simulation Section Editor: Dwayne Westenskow Intraoperative Ventilatory Strategies for Prevention of Pulmonary Atelectasis in Obese Patients Undergoing

BACKGROUND: Atelectasis occurs regularly after induction of general anesthesia, persists postoperatively, and may contribute to significant postoperative morbidity and additional health care costs. Laparoscopic surgery has been reported to be associated with an increased incidence of postoperative atelectasis. It has been shown that during general anesthesia, obese patients have a greater risk of atelectasis than nonobese patients. Preventing atelectasis is important for all patients but is especially important when caring for obese patients. METHODS: We randomly allocated 66 adult obese patients with a body mass index between 30 and 50 kg/m2 scheduled to undergo laparoscopic bariatric surgery into 3 groups. According to the recruitment maneuver used, the zero end-expiratory pressure (ZEEP) group (n 22) received the vital capacity maneuver (VCM) maintained for 7–8 s applied immediately after intubation plus ZEEP; the positive end-expiratory pressure (PEEP) 5 group (n 22) received the VCM maintained for 7–8 s applied immediately after intubation plus 5 cm H2O of PEEP; and the PEEP 10 group (n 22) received the VCM maintained for 7–8 s applied immediatel