Ventilación mecánica no invasiva en el periopertorio para el paciente con obesidad. Una revisión narrativa

CRITICAL CARE & EMERGENGY MEDICINE VOL. 5

Noninvasive Mechanical Ventilation in the Perioperative Period for the Obese Patient: A Narrative Review

Enviar Artículo

www.doi.org/10.58281/ccem060126-rev-nar-03

Ivan Uriel Gamez Valdez 1, José Heriberto Cuan Díaz 1, Flavio Morales Vázquez 1, Mauricio Rodrigo Ríos Zuñiga 1 .

1 Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

Editor
Gastón Daniel Martínez Sedas , Eduardo Perez Lozano .

Chair
Manuel Alberto Guerrero Gutierrez .

Abstract

Abstract: This narrative review highlights the relevance of noninvasive mechanical ventilation (NIV) as an essential intervention to optimize respiratory safety in obese patients during the perioperative period, a population characterized by markedly reduced functional residual capacity, increased alveolar collapse, and hypoventilation that elevate the risk of critical hypoxemia.
The analyzed evidence demonstrates that CPAP (Continuous Positive Airway Pressure) and BiPAP (Bilevel Positive Airway Pressure) improve oxygenation by enhancing alveolar recruitment and prolonging the safe apnea time, offering superior benefits compared with conventional oxygenation techniques. During the preoxygenation stage, multiple trials confirm that positive pressure reduces the incidence of peri-intubation hypoxemia, with greater impact in patients with elevated BMI or obstructive sleep apnea (OSA). During anesthetic induction, the application of CPAP between 7 and 10 cmH2O or BiPAP with an appropriate IPAP–EPAP (Inspiratory Positive Airway Pressure–Expiratory Positive Airway Pressure) gradient improves respiratory stability, reduces ventilatory effort, and prevents the rapid desaturation characteristic of this population. In the postoperative period, contemporary studies such as EXTUB-OBESE demonstrate that early application of NIV reduces respiratory failure and increases reintubation-free time, with particularly pronounced benefits in patients with morbid obesity. Additionally, BiPAP offers advantages in the presence of hypoventilation or hypercapnia, whereas CPAP is more effective when atelectasis predominates. Based on the findings of this review, it is recommended to use NIV systematically during preoxygenation in obese patients, select the modality according to the predominant pathophysiology, initiate CPAP and BiPAP with safe and titrated parameters guided by clinical response, and implement prophylactic use after extubation in patients with BMI ≥ 40 kg/m² or high respiratory risk.

Resumen:  La presente revisión narrativa destaca la relevancia de la ventilación mecánica no invasiva (VNI) como una intervención esencial para optimizar la seguridad respiratoria del paciente con obesidad durante el periodo perioperatorio, una población con marcada reducción de la capacidad residual funcional, mayor colapso alveolar e hipoventilación que incrementan el riesgo de hipoxemia crítica. La evidencia analizada demuestra que las modalidades CPAP (Presión Positiva continua en la Vía Aérea) y BiPAP (Presión Positiva en la Vía Aérea en Dos Niveles) mejoran la oxigenación al aumentar el reclutamiento alveolar y prolongar el tiempo seguro de apnea, con beneficios superiores a las técnicas convencionales de oxigenación. En la etapa de preoxigenación, múltiples ensayos confirman que la presión positiva disminuye la incidencia de hipoxemia peri intubación, con mayor impacto en pacientes con IMC elevado o apnea obstructiva del sueño (AOS).
Durante la inducción anestésica, la aplicación de CPAP entre 7 y 10 cmH₂O o BiPAP con un diferencial IPAP–EPAP (Presión Positiva Inspiratoria- Presión Positiva Espiratoria) adecuado mejora la estabilidad respiratoria, reduce el esfuerzo ventilatorio y previene la desaturación rápida característica de esta población. En el postoperatorio, estudios  contemporáneos como EXTUB-OBESE demuestran que la VNI aplicada precozmente reduce el fracaso respiratorio y aumenta el tiempo libre de reintubación, siendo especialmente beneficiosa en pacientes con obesidad mórbida. Además, el BiPAP ofrece ventajas en presencia de hipoventilación o hipercapnia, mientras que el CPAP resulta más efectivo cuando predomina la atelectasia. Con base en los hallazgos de esta revisión, se recomienda utilizar VNI de forma sistemática en la preoxigenación del paciente obeso, seleccionar la modalidad según la fisiopatología predominante, iniciar CPAP y BiPAP en parámetros seguros y titulados según respuesta clínica, e implementar su uso profiláctico tras la extubación en pacientes con IMC ≥ 40 kg/m² o riesgo respiratorio elevado.

Obesity, perioperative period, CPAP, BiPAP, sleep apnea obstructive, noninvasive ventilation

Ivan Uriel Gamez Valdez,
Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

José Heriberto Cuan Díaz.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

Flavio Morales Vázquez.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

Mauricio Rodrigo Ríos Zuñiga.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

  1. Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981 Apr 18;1(8225):862–865. doi: 10.1016/S0140-6736(81)92140-1.

  2. Duncan SR, Negrin RS, Mihm FG, Guilleminault C, Raffin TA. Nasal continuous positive airway pressure in atelectasis. Chest. 1987 Oct;92(4):621–624. doi: 10.1378/chest.92.4.621.

  3. Criner GJ, Gayen S, Zantah M, Dominguez Castillo E, Naranjo M, Lashari B, Pourshahid S, Gangemi A. Clinical review of non-invasive ventilation. Eur Respir J. 2024 Nov 7;64(5):2400396. doi: 10.1183/13993003.00396-2024.

  4. Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, Parthasarathy S, Quan SF, Rowley JA. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008 Apr 15;4(2):157–171. doi: 10.5664/jcsm.27133.

  5. Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, Belloni G, Vilianis G, Fiore G, Cavallo F, Ranieri VM. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA. 2005 Feb 2;293(5):589–595. doi: 10.1001/jama.293.5.589.

  6. Masa JF, Benítez ID, Sánchez-Quiroga MÁ, Gomez de Terreros FJ, Corral J, Romero A, et al. Effectiveness of CPAP vs. noninvasive ventilation based on disease severity in obesity hypoventilation syndrome and concomitant severe obstructive sleep apnea. Arch Bronconeumol. 2022 Mar;58(3):228–236. doi: 10.1016/j.arbres.2021.05.019.

  7. Wang X, Chen X, Gao J. Effect of positive airway pressure on obese patients undergoing surgery: a systematic review and meta-analysis. BMC Anesthesiol. 2024 Aug 9;24(1):281. doi: 10.1186/s12871-024-02665-9.

  8. Chiumello D, Chevallard G, Gregoretti C. Non-invasive ventilation in postoperative patients: a systematic review. Intensive Care Med. 2011 Jun;37(6):918–929. doi: 10.1007/s00134-011-2210-8.

  9. American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea. Anesthesiology. 2014 Feb;120(2):268–286. doi: 10.1097/ALN.0000000000000053.

  10. Wang X, Chen X, Gao J. Effect of positive airway pressure on obese patients undergoing surgery: a systematic review and meta-analysis. BMC Anesthesiol. 2024 Aug 9;24(1):281. doi: 10.1186/s12871-024-02665-9.

  11. Thota B, Jan KM, Oh MW, Moon TS. Airway management in patients with obesity. Saudi J Anaesth. 2022 Jan–Mar;16(1):76–81. doi: 10.4103/sja.sja_351_21.

  12. Ayenew AD, Melkie TB, Arefayne NR, Degu ZA, Admassie BM. Airway management and ventilation strategy among obese adult patients: a comprehensive review and analysis. Ann Med Surg (Lond). 2024 Dec 19;87(2):800–808. doi: 10.1097/MS9.0000000000002788.

  13. Sériès F, Genest C, Martin M, Boutin I, Marceau S, Bussières J, Minville C. CPAP is not needed in every sleep apnea patient awaiting bariatric surgery. Obes Surg. 2021 May;31(5):2161–2167. doi: 10.1007/s11695-021-05240-0.

  14. Sériès F, Genest C, Martin M, Boutin I, Marceau S, Bussières J, Minville C. CPAP is not needed in every sleep apnea patient awaiting bariatric surgery. Obes Surg. 2021;31(5):2161–2167. doi: 10.1007/s11695-021-05240-0.

  15. Chung F, Nagappa M, Singh M, Mokhlesi B. CPAP in the perioperative setting: evidence of support. Chest. 2016 Feb;149(2):586–597. doi: 10.1378/chest.15-1777.

  16. Pazzianotto-Forti EM, Baltieri L, Brigatto P, Costa CMD, Rocha MRSD, Rasera-Júnior I. Bilevel positive airway pressure in two moments after bariatric surgery. Rev Assoc Med Bras. 2019 Oct 10;65(9):1161–1167. doi: 10.1590/1806-9282.65.9.1161.

  17. Imperatore F, Gritti F, Esposito R, Giudice CD, Cafora C, Pennacchio F, Maglione F, Catauro A, Pace MC, Docimo L, Gambardella C. Non-invasive ventilation reduces postoperative respiratory failure in patients undergoing bariatric surgery: a retrospective analysis. Medicina (Kaunas). 2023 Aug 12;59(8):1457. doi: 10.3390/medicina59081457.

  18. Xu J, Wei Z, Li W, Wang W. Effect of different modes of positive airway pressure treatment on obesity hypoventilation syndrome: a systematic review and network meta-analysis. Sleep Med. 2022 Mar;91:51–58. doi: 10.1016/j.sleep.2022.01.008.

  19. La Via L, Cuttone G, Senussi Testa T, Duarte-Medrano G, Nuno-Lambarri N, Deana C, Maniaci A, Paternò DS, Zdravkovic I, Sorbello M. Non-invasive positive pressure ventilation for pre-oxygenation of critically ill patients before intubation. J Clin Med. 2025 Jul 29;14(15):5356. doi: 10.3390/jcm14155356.

  20. Gibbs KW, Semler MW, Driver BE, Seitz KP, Stempek SB, Taylor C, et al. Noninvasive ventilation for preoxygenation during emergency intubation. N Engl J Med. 2024 Jun 20;390(23):2165–2177. doi: 10.1056/NEJMoa2313680.

  21. Huynh DQ, Trieu NHK, Pham TTN. Preoxygenation strategies for endotracheal intubation in resource-limited settings: reframing the basics. Crit Care. 2025 Jun 23;29(1):259. doi: 10.1186/s13054-025-05508-2.

  22. Chiang TL, Tam KW, Chen JT, Wong CS, Yeh CT, Huang TY, et al. Non-invasive ventilation for preoxygenation before general anesthesia: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol. 2022 Sep 30;22(1):306. doi: 10.1186/s12871-022-01842-y.

  23. La Via L, Cuttone G, Senussi Testa T, Duarte-Medrano G, Nuno-Lambarri N, Deana C, Maniaci A, Paternò DS, Zdravkovic I, Sorbello M. Non-invasive positive pressure ventilation for pre-oxygenation of critically ill patients before intubation. J Clin Med. 2025 Jul 29;14(15):5356. doi: 10.3390/jcm14155356.

  24. Roveri G, Camporesi A, Hofer A, Kahlen S, Breidt F, Rauch S. Preoxygenation with and without positive end-expiratory pressure in lung-healthy volunteers: a randomized clinical trial. JAMA Netw Open. 2025 May 1;8(5):e2511569. doi: 10.1001/jamanetworkopen.2025.11569.

  25. Pensier J, Naudet-Lasserre A, Monet C, Capdevila M, Aarab Y, Lakbar I, et al. Noninvasive respiratory support following extubation in critically ill adults with obesity: a systematic review and network meta-analysis. EClinicalMedicine. 2024 Dec 16;79:103002. doi: 10.1016/j.eclinm.2024.103002.

  26. Wang X, Chen X, Gao J. Effect of positive airway pressure on obese patients undergoing surgery: a systematic review and meta-analysis. BMC Anesthesiol. 2024 Aug 9;24(1):281. doi: 10.1186/s12871-024-02665-9.

  27. De Jong A, Huguet H, Bignon A, Stephan F, Godet T, Collet L, et al. Noninvasive ventilation in postoperative critically ill patients with morbid obesity: secondary analysis of the EXTUBOBESE multicentre randomised clinical trial. Br J Anaesth. 2025 Nov;135(5):1477–1485. doi: 10.1016/j.bja.2025.09.002.

  28. Kachmar M, Wall-Wieler E, Liu Y, Zheng F, Singh P, Albaugh VL. Longitudinal changes in positive airway pressure device use after metabolic surgery: a 3-year matched cohort study of national claims data. Surg Obes Relat Dis. 2025 Jul;21(7):742–751. doi: 10.1016/j.soard.2025.01.009.

  29. Martinez Palau MG. Revisión sistemática sobre beneficios de la CPAP en comparación con otras intervenciones en el período postoperatorio de pacientes sometidos a cirugía bariátrica. Revista Electrónica AnestesiaR. 2022 Jun 6;14(5). doi: 10.30445/rear.v14i5.1123.

  30. Amra B, Balouchianzadeh S, Soltaninejad F, Schoebel C, Fietze I, Bateni MH, Abdar Esfahani M, Penzel T. Heart rate variability changes by non-invasive ventilation in obesity hypoventilation syndrome. Clin Respir J. 2021 Jul;15(7):770–778. doi: 10.1111/crj.13359.

  31. Roveri G, Camporesi A, Hofer A, Kahlen S, Breidt F, Rauch S. Preoxygenation with and without positive end-expiratory pressure in lung-healthy volunteers: a randomized clinical trial. JAMA Netw Open. 2025 May 1;8(5):e2511569. doi: 10.1001/jamanetworkopen.2025.11569.

  32. De Jong A, Bignon A, Stephan F, Godet T, Constantin JM, Asehnoune K, et al. Effect of non-invasive ventilation after extubation in critically ill patients with obesity in France: a multicentre, unblinded, pragmatic randomised clinical trial. Lancet Respir Med. 2023 Jun;11(6):530–539. doi: 10.1016/S2213-2600(22)00529-X.

  33. Thille AW, Le Pape S. Prophylactic noninvasive ventilation after extubation of obese patients. Am J Respir Crit Care Med. 2025 Feb;211(2):146–148. doi: 10.1164/rccm.202411-2199ED.

  34. Boscolo A, Sella N, Pettenuzzo T, Pistollato E, Zarantonello F, Ongaro S, Monteleone F, Medici F, Zanon P, Zambianchi A, et al. Noninvasive respiratory support for preoxygenation in emergency intubation: a systematic review and network meta-analysis. ERJ Open Res. 2025 Dec 15;11(6):00329-2025. doi: 10.1183/23120541.00329-2025.

[1] Ivan Uriel Gamez Valdez, José Heriberto Cuan Díaz, Flavio Morales Vázquez, and Mauricio Rodrigo Ríos Zuñiga. 2026. Ventilación mecánica no invasiva en el perioperatorio para el paciente con obesidad: una revisión narrativa. CRITICAL CARE & EMERGENGY MEDICINE 5, (January 2026), 76–86. https://doi.org/10.58281/ccem060126-rev-nar-03
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2992-6785

eISSN: 2992-6785
DOI: 10.3989/ccem

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www.doi.org/10.58281/ccem060126-rev-nar-03

Ivan Uriel Gamez Valdez 1, José Heriberto Cuan Díaz 1, Flavio Morales Vázquez 1, Mauricio Rodrigo Ríos Zuñiga 1 .

1 Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

Editor
Gastón Daniel Martínez Sedas , Eduardo Perez Lozano .

Chair
Manuel Alberto Guerrero Gutierrez .

Abstract

Abstract: This narrative review highlights the relevance of noninvasive mechanical ventilation (NIV) as an essential intervention to optimize respiratory safety in obese patients during the perioperative period, a population characterized by markedly reduced functional residual capacity, increased alveolar collapse, and hypoventilation that elevate the risk of critical hypoxemia.
The analyzed evidence demonstrates that CPAP (Continuous Positive Airway Pressure) and BiPAP (Bilevel Positive Airway Pressure) improve oxygenation by enhancing alveolar recruitment and prolonging the safe apnea time, offering superior benefits compared with conventional oxygenation techniques. During the preoxygenation stage, multiple trials confirm that positive pressure reduces the incidence of peri-intubation hypoxemia, with greater impact in patients with elevated BMI or obstructive sleep apnea (OSA). During anesthetic induction, the application of CPAP between 7 and 10 cmH2O or BiPAP with an appropriate IPAP–EPAP (Inspiratory Positive Airway Pressure–Expiratory Positive Airway Pressure) gradient improves respiratory stability, reduces ventilatory effort, and prevents the rapid desaturation characteristic of this population. In the postoperative period,
contemporary studies such as EXTUB-OBESE demonstrate that early application of NIV reduces respiratory failure and increases reintubation-free time, with particularly pronounced benefits in patients with morbid obesity. Additionally, BiPAP offers advantages in the presence of hypoventilation or hypercapnia, whereas CPAP is more effective when atelectasis predominates. Based on the findings of this review, it is recommended to use NIV systematically during preoxygenation in obese patients, select the modality according to the predominant pathophysiology, initiate CPAP and BiPAP with
safe and titrated parameters guided by clinical response, and implement prophylactic use after extubation in patients with BMI ≥ 40 kg/m² or high respiratory risk.

Resumen:  La presente revisión narrativa destaca la relevancia de la ventilación mecánica no invasiva (VNI) como una intervención esencial para optimizar la seguridad respiratoria del paciente con obesidad durante el periodo perioperatorio, una población con marcada reducción de la capacidad residual funcional, mayor colapso alveolar e hipoventilación que incrementan el riesgo de hipoxemia crítica. La evidencia analizada demuestra que las modalidades CPAP (Presión Positiva continua en la Vía Aérea) y BiPAP (Presión Positiva en la Vía Aérea en Dos Niveles) mejoran la oxigenación al aumentar el reclutamiento alveolar y prolongar el tiempo seguro de apnea, con beneficios superiores a las técnicas convencionales de oxigenación. En la etapa de preoxigenación, múltiples ensayos confirman que la presión positiva disminuye la incidencia de hipoxemia peri intubación, con mayor impacto en pacientes con IMC elevado o apnea obstructiva del sueño (AOS).
Durante la inducción anestésica, la aplicación de CPAP entre 7 y 10 cmH₂O o BiPAP con un diferencial IPAP–EPAP (Presión Positiva Inspiratoria- Presión Positiva Espiratoria) adecuado mejora la estabilidad respiratoria, reduce el esfuerzo ventilatorio y previene la desaturación rápida característica de esta población. En el postoperatorio, estudios  contemporáneos como EXTUB-OBESE demuestran que la VNI aplicada precozmente reduce el fracaso respiratorio y aumenta el tiempo libre de reintubación, siendo especialmente beneficiosa en pacientes con obesidad mórbida. Además, el BiPAP ofrece ventajas en presencia de hipoventilación o hipercapnia, mientras que el CPAP resulta más efectivo cuando predomina la atelectasia. Con base en los hallazgos de esta revisión, se recomienda utilizar VNI de forma sistemática en la preoxigenación del paciente obeso, seleccionar la modalidad según la fisiopatología predominante, iniciar CPAP y BiPAP en parámetros seguros y titulados según respuesta clínica, e implementar su uso profiláctico tras la extubación en pacientes con IMC ≥ 40 kg/m² o riesgo respiratorio elevado.

Obesity, perioperative period, CPAP, BiPAP, sleep apnea obstructive, noninvasive ventilation

Ivan Uriel Gamez Valdez,
Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

José Heriberto Cuan Díaz.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

Flavio Morales Vázquez.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

Mauricio Rodrigo Ríos Zuñiga.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

  1. Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981 Apr 18;1(8225):862–865. doi: 10.1016/S0140-6736(81)92140-1.

  2. Duncan SR, Negrin RS, Mihm FG, Guilleminault C, Raffin TA. Nasal continuous positive airway pressure in atelectasis. Chest. 1987 Oct;92(4):621–624. doi: 10.1378/chest.92.4.621.

  3. Criner GJ, Gayen S, Zantah M, Dominguez Castillo E, Naranjo M, Lashari B, Pourshahid S, Gangemi A. Clinical review of non-invasive ventilation. Eur Respir J. 2024 Nov 7;64(5):2400396. doi: 10.1183/13993003.00396-2024.

  4. Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, Parthasarathy S, Quan SF, Rowley JA. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008 Apr 15;4(2):157–171. doi: 10.5664/jcsm.27133.

  5. Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, Belloni G, Vilianis G, Fiore G, Cavallo F, Ranieri VM. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA. 2005 Feb 2;293(5):589–595. doi: 10.1001/jama.293.5.589.

  6. Masa JF, Benítez ID, Sánchez-Quiroga MÁ, Gomez de Terreros FJ, Corral J, Romero A, et al. Effectiveness of CPAP vs. noninvasive ventilation based on disease severity in obesity hypoventilation syndrome and concomitant severe obstructive sleep apnea. Arch Bronconeumol. 2022 Mar;58(3):228–236. doi: 10.1016/j.arbres.2021.05.019.

  7. Wang X, Chen X, Gao J. Effect of positive airway pressure on obese patients undergoing surgery: a systematic review and meta-analysis. BMC Anesthesiol. 2024 Aug 9;24(1):281. doi: 10.1186/s12871-024-02665-9.

  8. Chiumello D, Chevallard G, Gregoretti C. Non-invasive ventilation in postoperative patients: a systematic review. Intensive Care Med. 2011 Jun;37(6):918–929. doi: 10.1007/s00134-011-2210-8.

  9. American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea. Anesthesiology. 2014 Feb;120(2):268–286. doi: 10.1097/ALN.0000000000000053.

  10. Wang X, Chen X, Gao J. Effect of positive airway pressure on obese patients undergoing surgery: a systematic review and meta-analysis. BMC Anesthesiol. 2024 Aug 9;24(1):281. doi: 10.1186/s12871-024-02665-9.

  11. Thota B, Jan KM, Oh MW, Moon TS. Airway management in patients with obesity. Saudi J Anaesth. 2022 Jan–Mar;16(1):76–81. doi: 10.4103/sja.sja_351_21.

  12. Ayenew AD, Melkie TB, Arefayne NR, Degu ZA, Admassie BM. Airway management and ventilation strategy among obese adult patients: a comprehensive review and analysis. Ann Med Surg (Lond). 2024 Dec 19;87(2):800–808. doi: 10.1097/MS9.0000000000002788.

  13. Sériès F, Genest C, Martin M, Boutin I, Marceau S, Bussières J, Minville C. CPAP is not needed in every sleep apnea patient awaiting bariatric surgery. Obes Surg. 2021 May;31(5):2161–2167. doi: 10.1007/s11695-021-05240-0.

  14. Sériès F, Genest C, Martin M, Boutin I, Marceau S, Bussières J, Minville C. CPAP is not needed in every sleep apnea patient awaiting bariatric surgery. Obes Surg. 2021;31(5):2161–2167. doi: 10.1007/s11695-021-05240-0.

  15. Chung F, Nagappa M, Singh M, Mokhlesi B. CPAP in the perioperative setting: evidence of support. Chest. 2016 Feb;149(2):586–597. doi: 10.1378/chest.15-1777.

  16. Pazzianotto-Forti EM, Baltieri L, Brigatto P, Costa CMD, Rocha MRSD, Rasera-Júnior I. Bilevel positive airway pressure in two moments after bariatric surgery. Rev Assoc Med Bras. 2019 Oct 10;65(9):1161–1167. doi: 10.1590/1806-9282.65.9.1161.

  17. Imperatore F, Gritti F, Esposito R, Giudice CD, Cafora C, Pennacchio F, Maglione F, Catauro A, Pace MC, Docimo L, Gambardella C. Non-invasive ventilation reduces postoperative respiratory failure in patients undergoing bariatric surgery: a retrospective analysis. Medicina (Kaunas). 2023 Aug 12;59(8):1457. doi: 10.3390/medicina59081457.

  18. Xu J, Wei Z, Li W, Wang W. Effect of different modes of positive airway pressure treatment on obesity hypoventilation syndrome: a systematic review and network meta-analysis. Sleep Med. 2022 Mar;91:51–58. doi: 10.1016/j.sleep.2022.01.008.

  19. La Via L, Cuttone G, Senussi Testa T, Duarte-Medrano G, Nuno-Lambarri N, Deana C, Maniaci A, Paternò DS, Zdravkovic I, Sorbello M. Non-invasive positive pressure ventilation for pre-oxygenation of critically ill patients before intubation. J Clin Med. 2025 Jul 29;14(15):5356. doi: 10.3390/jcm14155356.

  20. Gibbs KW, Semler MW, Driver BE, Seitz KP, Stempek SB, Taylor C, et al. Noninvasive ventilation for preoxygenation during emergency intubation. N Engl J Med. 2024 Jun 20;390(23):2165–2177. doi: 10.1056/NEJMoa2313680.

  21. Huynh DQ, Trieu NHK, Pham TTN. Preoxygenation strategies for endotracheal intubation in resource-limited settings: reframing the basics. Crit Care. 2025 Jun 23;29(1):259. doi: 10.1186/s13054-025-05508-2.

  22. Chiang TL, Tam KW, Chen JT, Wong CS, Yeh CT, Huang TY, et al. Non-invasive ventilation for preoxygenation before general anesthesia: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol. 2022 Sep 30;22(1):306. doi: 10.1186/s12871-022-01842-y.

  23. La Via L, Cuttone G, Senussi Testa T, Duarte-Medrano G, Nuno-Lambarri N, Deana C, Maniaci A, Paternò DS, Zdravkovic I, Sorbello M. Non-invasive positive pressure ventilation for pre-oxygenation of critically ill patients before intubation. J Clin Med. 2025 Jul 29;14(15):5356. doi: 10.3390/jcm14155356.

  24. Roveri G, Camporesi A, Hofer A, Kahlen S, Breidt F, Rauch S. Preoxygenation with and without positive end-expiratory pressure in lung-healthy volunteers: a randomized clinical trial. JAMA Netw Open. 2025 May 1;8(5):e2511569. doi: 10.1001/jamanetworkopen.2025.11569.

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[1] Ivan Uriel Gamez Valdez, José Heriberto Cuan Díaz, Flavio Morales Vázquez, and Mauricio Rodrigo Ríos Zuñiga. 2026. Ventilación mecánica no invasiva en el perioperatorio para el paciente con obesidad: una revisión narrativa. CRITICAL CARE & EMERGENGY MEDICINE 5, (January 2026), 76–86. https://doi.org/10.58281/ccem060126-rev-nar-03
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