Intraoperative lung-protective ventilation can reduce postoperative pulmonary complications. The added protection of positive end-expiratory pressure (PEEP) remains uncertain. In this issue of Anesthesiology, Pereira et al. demonstrate that PEEP requirements vary widely among patients. Individually-titrated PEEP during anesthesia reduces postoperative atelectasis while improving intraoperative oxygenation and driving pressures. In an accompanying Editorial View, Kacmarek and Villar discuss this new clinical trial in the context of previous trials evaluating the risks and benefits of using PEEP in the operating room.

  • Pereira et al.: Individual Positive End-expiratory Pressure Settings Optimize Intraoperative Mechanical Ventilation and Reduce Postoperative Atelectasis, p. 1070

  • Kacmarek and Villar: Lung-protective Ventilation in the Operating Room: Individualized Positive End-expiratory Pressure Is Needed! p. 1057