We read with great interest the recent article by Simon et al. In this study, the authors have shown that individualized positive end-expiratory pressure (PEEP) exerts lower driving pressure. This in turn proved the redistribution of ventilation toward dependent lung areas, as measured by electrical impedance tomography. These sound results imply great notions regarding intraoperative respiratory management. However, we highlight four concerns regarding the methodology used.

First, the study combined data from a multicenter and a single-center trial. This was likely to cause selection bias. The inclusion periods were separated at 4-yr intervals. The authors divided the combined cohort into three treatment groups: individualized PEEP, fixed low PEEP, and fixed PEEP of 12 cm H2O. The differences in the patient characteristics were unclear. The Assess Respiratory Risk in Surgical Patients in Catalonia...

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