Protective Ventilation With Higher Versus Lower PEEP During General Anesthesia for Surgery in Obese Patients

Exclusion Criteria

• •Age \< 18 years
• •Previous lung surgery (any)
• •Persistent hemodynamic instability, intractable shock (considered hemodynamically unsuitable for the study by the patient's managing physician)
• •History of previous severe chronic obstructive pulmonary disease (COPD) (non-invasive ventilation and/or oxygen therapy at home, repeated systemic corticosteroid therapy for acute exacerbations of COPD)
• •Recent immunosuppressive medication (patients receiving chemotherapy or radiation therapy up to two months prior to surgery)
• •Severe cardiac disease (New York Heart Association class III or IV, acute coronary syndrome or persistent ventricular tachyarrhythmias)
• •Invasive mechanical ventilation longer than 30 minutes (e.g., general anesthesia for surgery) within last 30 days
• •Pregnancy (excluded by anamneses and/or laboratory analysis)
• •Prevalent acute respiratory distress syndrome expected to require prolonged postoperative mechanical ventilation
• •Severe pulmonary arterial hypertension, defined as systolic pulmonary artery pressure \> 40 mmHg
• •Intracranial injury or tumor
• •Neuromuscular disease (any)
• •Need for intraoperative prone or lateral decubitus position
• •Need for one-lung ventilation
• •Cardiac surgery
• •Neurosurgery
• •Planned reintubation following surgery
• •Enrolled in other interventional study or refusal of informed consent