We read with great interest a very informative and well-conducted study by Shono et al. titled “Positive End-expiratory Pressure and Distribution of Ventilation in Pneumoperitoneum Combined with Steep Trendelenburg Position” published in the Journal. The study has objectively shown that application of positive end-expiratory pressure (PEEP) of 15 cm H2O resulted in more homogeneous ventilation and favorable pulmonary physiologic effects during robot-assisted laparoscopic prostatectomy, but did not improve postoperative lung function. Whereas that authors have focused on the beneficial pulmonary effects of high PEEP values, the article would benefit readers considerably if the authors could address its potential ill effects on some other organ systems.

In this regard we wish to highlight our concern regarding application of high PEEP on intracranial pressure (ICP) in patients given a steep Trendelenberg position. It is known that...

You do not currently have access to this content.