We thank Zheng et al. for their interest and positive comments on our recently published study in Anesthesiology. We subscribe to their emphasis on the strong relation between perioperative atelectasis and ventilator-induced lung injury in anesthetized children. We agree that the best possible study design is a randomized controlled trial with a larger number of patients and including postoperative management. Our exploratory cohort study, however, was designed to assess the effects of capnoperitoneum on lung strain-stress in anesthetized children. By using a multimodal monitoring, we aimed at better understanding these mechanisms of ventilator-induced lung injury in children, and the responses to an individualized protective ventilation. While not suited for a randomized controlled trial, such a design provides essential information for the improvement and enrichment of future studies. As the authors clearly state, even in a more controlled experimental setup like ours, some children did not achieve...

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