The ideal positive end-expiratory pressure (PEEP) management during surgery is still elusive. In the current issue of Anesthesiology, Simon et al. and the PROVEnet investigators provide another step forward on the long road of searching for a physiology-supported PEEP strategy. Such a PEEP strategy aims to optimize alveolar patency, minimize lung strain, and improve gas exchange, but the ideal long-term goal of any intraoperative management would be to reduce postoperative pulmonary complications (e.g., atelectasis, pneumonia) and improve overall clinical outcomes. Pursuing the appropriate PEEP strategy is even more imperative in obese patients because of their known reduced expiratory reserve volume and functional residual capacity and increased risk of atelectasis and hypoxemia. For an in-depth review of the consequences of obesity on the respiratory system, we refer the reader to excellent available reviews on...

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