Protective mechanical ventilation characterizes a strategy aimed at preventing lung overdistension (volutrauma), derecruitment (atelectrauma), and dysfunctional inflammation (biotrauma). It is usually implemented with physiologic tidal volumes, for which there is strong evidence of outcome benefits, and lung expansion including positive end-expiratory pressure (PEEP) and recruitment maneuvers, with persisting controversy. Protective ventilation has been mostly studied in critical care, despite the known effects of intraoperative ventilatory settings on postoperative pulmonary outcomes. Current laparoscopic robotic surgery techniques challenge the anesthesiologist to optimize mechanical ventilation in conditions where the patient’s physiologic complexity (e.g., obesity) frequently compounds with surgical physiologic burden (pneumoperitoneum, unphysiological Trendelenburg position). Unfortunately, objective data are scarce to guide clinical practice in these procedures.

In this issue of Anesthesiology, the article by Tharp et al. regarding 91 patients with body mass index (BMI)...

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