Rol de la PEEP en la Prevención de Complicaciones Pulmonares Postoperatorias en pacientes con obesidad: una revisión narrativa
CRITICAL CARE & EMERGENGY MEDICINE VOL. 5
Role of PEEP in the Prevention of Postoperative Pulmonary Complications in Obese Patients: A Narrative Review
- 8 enero, 2026
- Revisión narrativa, Volumen 5
Flavio Morales Vázquez 1 
, Mauricio Rodrigo Ríos Zúñiga 1 , José Heriberto Cuán Díaz 1 , Iván Uriel Gámez Valdez 1 .
1 Fellow en Alta Especialidad en Anestesiología Bariátrica. Centro Médico Bariátrico. Tijuana, México.
Editor
Gerardo Alberto Solis Perez , Andrea Fuentes Conde .
Chair
Diego Escarraman Martinez .
Abstract
Abstract: Obesity poses one of the greatest contemporary challenges in anesthesiology, particularly in intraoperative ventilatory management, where the combination of altered respiratory mechanics, reduced functional residual capacity, and early alveolar closure demands precise, physiology-based decision- making. Although PEEP is a fundamental tool, the available literature remains fragmented and heterogeneous; few reviews critically and comparatively integrate the most recent evidence regarding its optimal titration in obese patients undergoing non-cardiac surgery. This work addresses that gap by offering an updated synthesis encompassing more than a decade of clinical trials, meta-analyses, and specialized reviews, making it a particularly valuable contribution in a field where recommendations are often extrapolated from non-obese populations.
The most consistent findings indicate that moderate–high PEEP, individualized using parameters such as compliance or driving pressure, provides clear benefits in oxygenation and reduction of postoperative atelectasis, without significant hemodynamic compromise. However, this approach is not yet standardized, underscoring the relevance of studies such as the present one, which consolidate dispersed evidence and highlight the urgent need for research aimed at defining reproducible algorithms. Individualizing ventilation in the obese patient is not merely advisable; it is a physiological imperative that this analysis brings to the forefront
Resumen
Resumen: La obesidad plantea uno de los mayores retos actuales en anestesiología, especialmente en el manejo ventilatorio intraoperatorio, donde la combinación de mecánica respiratoria alterada, disminución de la capacidad residual funcional y cierre alveolar precoz exige decisiones precisas y basadas en fisiología. Aunque la presión positiva al final de la respiración (PEEP) es una herramienta fundamental, la literatura disponible sigue siendo fragmentada y heterogénea; pocas revisiones integran, de manera crítica y comparativa, la evidencia más reciente sobre su titulación óptima en pacientes con obesidad sometidos a cirugía no cardíaca. Este trabajo aborda esa brecha, ofreciendo una síntesis actualizada que concentra más de una década de ensayos clínicos, metaanálisis y revisiones especializadas, lo que lo convierte en un análisis particularmente
valioso en un campo donde las recomendaciones
suelen ser extrapoladas de poblaciones no obesas. Los hallazgos más consistentes muestran que un PEEP moderado–alto, ajustado de forma individualizada mediante parámetros como la compliance o la presión de conducción,
proporciona beneficios claros en oxigenación y reducción de atelectasias, sin un impacto hemodinámico significativo. Sin embargo, este enfoque aún no está estandarizado, lo que subraya la relevancia de trabajos como el presente, que integran la evidencia dispersa y resaltan la necesidad urgente de estudios que definan algoritmos reproducibles. Individualizar
la ventilación en el paciente con obesidad no solo es una recomendación, es una obligación fisiológica que este análisis pone en primer plano.
Keywords
PEEP; obesity; general anesthesia; mechanical ventilation; postoperative pulmonary complications; driving pressure.
Biografias de autores
Flavio Morales Vázquez.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Centro Médico Bariátrico. Tijuana, México.
Mauricio Rodrigo Ríos Zúñiga.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Centro Médico Bariátrico. Tijuana, México.
José Heriberto Cuán Díaz.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Centro Médico Bariátrico. Tijuana, México.
Iván Uriel Gámez Valdez.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Centro Médico Bariátrico. Tijuana, México.
Referencias
World Health Organization. Obesity and overweight [Internet]. Geneva: World Health Organization; 2025 May 7 [cited 2025 Dec 23]. Available from: https://www.who.int/es/news-room/fact-sheets/detail/obesity-and-overweight
2.- Basto-Abreu A, López-Olmedo N, Rojas-Martínez R, Aguilar-Salinas CA, Moreno-Banda GL, Carnalla M, et al. Prevalencia de prediabetes y diabetes en México: Ensanut 2022. Salud Publica Mex. 2023 Jun;65(Suppl 1):S163–S168. doi: 10.21149/14832.
3.- De Jong A, Wrigge H, Hedenstierna G, Gattinoni L, Chiumello D, Frat JP, et al. How to ventilate obese patients in the ICU. Intensive Care Med. 2020 Dec;46(12):2423–2435. doi: 10.1007/s00134-020-06286-x.
4.- Grieco DL, Anzellotti GM, Russo A, Bongiovanni F, Costantini B, D’Indinosante M, et al. Airway closure during surgical pneumoperitoneum in obese patients. Anesthesiology. 2019 Jul;131(1):58–73. doi: 10.1097/ALN.0000000000002662.
5.- Hedenstierna G, Chen L, Brochard L. Airway closure, more harmful than atelectasis in intensive care? Intensive Care Med. 2020 Dec;46(12):2373–2376. doi: 10.1007/s00134-020-06144-w.
6.- Barbosa FT, Castro AA, de Sousa-Rodrigues CF. Positive end-expiratory pressure (PEEP) during anaesthesia for prevention of mortality and postoperative pulmonary complications. Cochrane Database Syst Rev. 2014 Jun 12;2014(6):CD007922. doi: 10.1002/14651858.CD007922.pub3.
7.- Chen C, Shang P, Yao Y; Evidence in Cardiovascular Anesthesia (EICA) Group. Positive end-expiratory pressure and postoperative pulmonary complications in laparoscopic bariatric surgery: systematic review and meta-analysis. BMC Anesthesiol. 2024 Aug 9;24(1):282. doi: 10.1186/s12871-024-02658-8.
8.- Yessenbayeva GA, Meyerbekova AM, Kim SI, Zhumabayev MB, Berdiyarova GS, Shalekenov SB, et al. Impact of a positive end-expiratory pressure on oxygenation, respiratory compliance, and hemodynamics in obese patients undergoing laparoscopic surgery in reverse Trendelenburg position: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol. 2025 Feb 7;25(1):61. doi: 10.1186/s12871-025-02933-2.
9.- Szigetváry C, Szabó GV, Dembrovszky F, Ocskay K, Engh MA, Turan C, et al. Individualised positive end-expiratory pressure settings reduce the incidence of postoperative pulmonary complications: a systematic review and meta-analysis. J Clin Med. 2024 Nov 11;13(22):6776. doi: 10.3390/jcm13226776.
10.- Mo J, Wang D, Xiao J, Chen Q, An R, Liu HL. Effects of lung protective ventilation strategies on postoperative pulmonary complications after noncardiac surgery: a network meta-analysis of randomized controlled trials. BMC Anesthesiol. 2024 Sep 28;24(1):346. doi: 10.1186/s12871-024-02737-w.
11.- Gutiérrez MAG, Nieto ORP, Pérez GAS, Martínez DE, Antolinez-Motta JM, Zamarrón-López EI. Ventilación mecánica en el paciente con obesidad. Rev Chil Anest. 2024;53(4). doi: 10.25237/revchilanestv53n4-15.
12.- PROVE Network Investigators; Hemmes SN, Gama de Abreu M, Pelosi P, Schultz MJ. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014 Aug 9;384(9942):495–503. doi: 10.1016/S0140-6736(14)60416-5.
13.- Bluth T, Serpa Neto A, Schultz MJ, Pelosi P, Gama de Abreu M, PROBESE Collaborative Group, et al. Effect of intraoperative high positive end-expiratory pressure with recruitment maneuvers vs low PEEP on postoperative pulmonary complications in obese patients: a randomized clinical trial. JAMA. 2019 Jun 18;321(23):2292–2305. doi: 10.1001/jama.2019.7505.
14.- Li X, Liu H, Wang J, Ni ZL, Liu ZX, Jiao JL, Han Y, Cao JL. Individualized positive end-expiratory pressure on postoperative atelectasis in patients with obesity: a randomized controlled clinical trial. Anesthesiology. 2023 Sep 1;139(3):262–273. doi: 10.1097/ALN.0000000000004603.
15.- Östberg E, Thorisson A, Enlund M, Zetterström H, Hedenstierna G, Edmark L. Positive end-expiratory pressure and postoperative atelectasis: a randomized controlled trial. Anesthesiology. 2019 Oct;131(4):809–817. doi: 10.1097/ALN.0000000000002764.
16.- Östberg E, Larsson A, Wagner P, Eriksson S, Edmark L. Positive end-expiratory pressure and emergence preoxygenation after bariatric surgery: effect on postoperative oxygenation: a randomized controlled trial. Eur J Anaesthesiol. 2025 Jan;42(1):54–63. doi: 10.1097/EJA.0000000000002071.
17.- Yang G, Zhang P, Li L, Wang J, Jiao P, Wang J, Chu Q. Driving pressure-guided ventilation in obese patients undergoing laparoscopic sleeve gastrectomy: a randomized controlled trial. Diabetes Metab Syndr Obes. 2023 May 24;16:1515–1523. doi: 10.2147/DMSO.S405804.
18.- Sun YH, Yang XL, Dong BB, Liu Q. Effect of driving pressure-guided positive end-expiratory pressure on respiratory mechanics and clinical outcomes in surgical patients: a systematic review and meta-analysis of randomized controlled trials. Ann Med. 2025 Dec;57(1):2543978. doi: 10.1080/07853890.2025.2543978.
19.- Pérez Nieto OR, Zamarrón López EI, Guerrero Gutiérrez MA, Deloya Tomás E, Soriano Orozco R, Sánchez Díaz JS, et al. PEEP: dos lados de la misma moneda. Medicina Crítica. 2021;35:34–46. doi: 10.35366/99152.
20.- Fuller BM, Ferguson IT, Mohr NM, Drewry AM, Palmer C, Wessman BT, et al. Lung-protective ventilation initiated in the emergency department (LOV-ED): a quasi-experimental, before-after trial. Ann Emerg Med. 2017 Sep;70(3):406–418.e4. doi: 10.1016/j.annemergmed.2017.01.013.
21.- Ball L, Pelosi P. How I ventilate an obese patient. Crit Care. 2019 May 16;23(1):176. doi: 10.1186/s13054-019-2466-x.
22.- Choi JY, Al-Saedy MA, Carlson B. Positive end-expiratory pressure and postoperative complications in patients with obesity: a review and meta-analysis. Obesity (Silver Spring). 2023 Apr;31(4):955–964. doi: 10.1002/oby.23675.
23.- Meshram T, Dang D, Sharma A, Kumari K, Rathod D, Bhatia P. Effects of intraoperative recruitment maneuver in patients with obesity undergoing laparoscopic surgery: a narrative review. J Anaesthesiol Clin Pharmacol. 2025 Jan-Mar;41(1):26–35. doi: 10.4103/joacp.joacp_397_23.
24.- Gómez-Nieto GM, Nando-Villicaña CC, Achar-Farca T. Cambios fisiológicos provocados por la posición del paciente y el neumoperitoneo en procedimientos laparoscópicos. Rev Mex Cir Endoscop. 2021;22(2):77–83. doi: 10.35366/104405.
25.- Boesing C, Schaefer L, Rocco PRM, Luecke T, Krebs J. Positive end-expiratory pressure optimisation during general anaesthesia in patients with obesity: a narrative review of respiratory and cardiovascular outcomes. Br J Anaesth. 2025 Oct 16;S0007-0912(25)00639-7. doi: 10.1016/j.bja.2025.09.009.
26.- Rajendran P, Karim HMR, Panda CK, Neema PK, Dey S. Preintubation machine-delivered pressure support ventilation with positive end-expiratory pressure versus manual bag-mask ventilation for oxygenation in overweight and obese patients: a randomized pilot study. Cureus. 2023 Sep 13;15(9):e45185. doi: 10.7759/cureus.45185.
27.- Wrigge H, Petroff D, Fernandez-Bustamante A. Pressure for high positive end-expiratory pressure in obese surgical patients is growing. Anesthesiology. 2023 Sep 1;139(3):239–243. doi: 10.1097/ALN.0000000000004665.
28.- Cavalcanti AB, Amato MBP, Serpa-Neto A. The elusive search for “best PEEP” and whether esophageal pressure monitoring helps. JAMA. 2019 Mar 5;321(9):839–841. doi: 10.1001/jama.2019.0267.
29.- Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015 Feb 19;372(8):747–755. doi: 10.1056/NEJMsa1410639.
30.- Silva PL, Rocco PRM. The basics of respiratory mechanics: ventilator-derived parameters. Ann Transl Med. 2018 Oct;6(19):376. doi: 10.21037/atm.2018.06.06.
31.- Regli A, Mahendran R, Fysh ET, Roberts B, Noffsinger B, De Keulenaer BL. Matching positive end-expiratory pressure to intra-abdominal pressure improves oxygenation in a porcine sick lung model of intra-abdominal hypertension. Crit Care. 2012 Oct 26;16(5):R208. doi: 10.1186/cc11840.
How to Cite / Como citar
[1] Flavio Morales Vázquez, Mauricio Rodrigo Ríos Zúñiga, José Heriberto Cuán Díaz, and Iván Uriel Gámez Valdez. 2026. Rol de la PEEP en la prevención de complicaciones pulmonares postoperatorias en pacientes con obesidad: una revisión narrativa. CRITICAL CARE & EMERGENGY MEDICINE 5, (January 2026), 50–58. https://doi.org/10.58281/ccem060126-rev-nar-06
Licencia
© 2025 Critical Care & Emergency Medicine by Ediciones Prado. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) .
The copyrights of the articles published in Critical Care & Emergency Medicine belong to Ediciones Prado. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Critical Care & Emergency Medicine without prior authorization for non-commercial use.
ISSN
2992-6785
eISSN: 2992-6785
DOI: 10.3989/ccem
Indexación
Patrocinadores
- 8 enero, 2026
- Revisión narrativa, Volumen 5
Flavio Morales Vázquez 1 , Mauricio Rodrigo Ríos Zúñiga 1 , José Heriberto Cuán Díaz 1 , Iván Uriel Gámez Valdez 1 .
1 Fellow en Alta Especialidad en Anestesiología Bariátrica. Centro Médico Bariátrico. Tijuana, México.
Editor
Gerardo Alberto Solis Perez , Andrea Fuentes Conde .
Chair
Diego Escarraman Martinez .
Abstract
Abstract: Obesity poses one of the greatest contemporary challenges in anesthesiology, particularly in intraoperative ventilatory management, where the combination of altered respiratory mechanics, reduced functional residual capacity, and early alveolar closure demands precise, physiology-based decision- making. Although PEEP is a fundamental tool, the available literature remains fragmented and heterogeneous; few reviews critically and comparatively integrate the most recent evidence regarding its optimal titration in obese patients undergoing non-cardiac surgery. This work addresses that gap by offering an updated synthesis encompassing more than a decade of clinical trials, meta-analyses, and specialized reviews, making it a particularly valuable contribution in a field where recommendations are often extrapolated from non-obese populations.
The most consistent findings indicate that moderate–high PEEP, individualized using parameters such as compliance or driving pressure, provides clear benefits in oxygenation and reduction of postoperative atelectasis, without significant hemodynamic compromise. However, this approach is not yet standardized, underscoring the relevance of studies such as the present one, which consolidate dispersed evidence and highlight the urgent need for research aimed at defining reproducible algorithms. Individualizing ventilation in the obese patient is not merely advisable; it is a physiological imperative that this analysis brings to the forefront
Resumen
Resumen: La obesidad plantea uno de los mayores retos actuales en anestesiología, especialmente en el manejo ventilatorio intraoperatorio, donde la combinación de mecánica respiratoria alterada, disminución de la capacidad residual funcional y cierre alveolar precoz exige decisiones precisas y basadas en fisiología. Aunque la presión positiva al final de la respiración (PEEP) es una herramienta fundamental, la literatura disponible sigue siendo fragmentada y heterogénea; pocas revisiones integran, de manera crítica y comparativa, la evidencia más reciente sobre su titulación óptima en pacientes con obesidad sometidos a cirugía no cardíaca. Este trabajo aborda esa brecha, ofreciendo una síntesis actualizada que concentra más de una década de ensayos clínicos, metaanálisis y revisiones especializadas, lo que lo convierte en un análisis particularmente
valioso en un campo donde las recomendaciones
suelen ser extrapoladas de poblaciones no obesas. Los hallazgos más consistentes muestran que un PEEP moderado–alto, ajustado de forma individualizada mediante parámetros como la compliance o la presión de conducción,
proporciona beneficios claros en oxigenación y reducción de atelectasias, sin un impacto hemodinámico significativo. Sin embargo, este enfoque aún no está estandarizado, lo que subraya la relevancia de trabajos como el presente, que integran la evidencia dispersa y resaltan la necesidad urgente de estudios que definan algoritmos reproducibles. Individualizar
la ventilación en el paciente con obesidad no solo es una recomendación, es una obligación fisiológica que este análisis pone en primer plano.
Keywords
PEEP; obesity; general anesthesia; mechanical ventilation; postoperative pulmonary complications; driving pressure.
Biografias de autores
Flavio Morales Vázquez.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Centro Médico Bariátrico. Tijuana, México.
Mauricio Rodrigo Ríos Zúñiga.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Centro Médico Bariátrico. Tijuana, México.
José Heriberto Cuán Díaz.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Centro Médico Bariátrico. Tijuana, México.
Iván Uriel Gámez Valdez.
Fellow en Alta Especialidad en Anestesiología Bariátrica. Centro Médico Bariátrico. Tijuana, México.
Referencias
World Health Organization. Obesity and overweight [Internet]. Geneva: World Health Organization; 2025 May 7 [cited 2025 Dec 23]. Available from: https://www.who.int/es/news-room/fact-sheets/detail/obesity-and-overweight
2.- Basto-Abreu A, López-Olmedo N, Rojas-Martínez R, Aguilar-Salinas CA, Moreno-Banda GL, Carnalla M, et al. Prevalencia de prediabetes y diabetes en México: Ensanut 2022. Salud Publica Mex. 2023 Jun;65(Suppl 1):S163–S168. doi: 10.21149/14832.
3.- De Jong A, Wrigge H, Hedenstierna G, Gattinoni L, Chiumello D, Frat JP, et al. How to ventilate obese patients in the ICU. Intensive Care Med. 2020 Dec;46(12):2423–2435. doi: 10.1007/s00134-020-06286-x.
4.- Grieco DL, Anzellotti GM, Russo A, Bongiovanni F, Costantini B, D’Indinosante M, et al. Airway closure during surgical pneumoperitoneum in obese patients. Anesthesiology. 2019 Jul;131(1):58–73. doi: 10.1097/ALN.0000000000002662.
5.- Hedenstierna G, Chen L, Brochard L. Airway closure, more harmful than atelectasis in intensive care? Intensive Care Med. 2020 Dec;46(12):2373–2376. doi: 10.1007/s00134-020-06144-w.
6.- Barbosa FT, Castro AA, de Sousa-Rodrigues CF. Positive end-expiratory pressure (PEEP) during anaesthesia for prevention of mortality and postoperative pulmonary complications. Cochrane Database Syst Rev. 2014 Jun 12;2014(6):CD007922. doi: 10.1002/14651858.CD007922.pub3.
7.- Chen C, Shang P, Yao Y; Evidence in Cardiovascular Anesthesia (EICA) Group. Positive end-expiratory pressure and postoperative pulmonary complications in laparoscopic bariatric surgery: systematic review and meta-analysis. BMC Anesthesiol. 2024 Aug 9;24(1):282. doi: 10.1186/s12871-024-02658-8.
8.- Yessenbayeva GA, Meyerbekova AM, Kim SI, Zhumabayev MB, Berdiyarova GS, Shalekenov SB, et al. Impact of a positive end-expiratory pressure on oxygenation, respiratory compliance, and hemodynamics in obese patients undergoing laparoscopic surgery in reverse Trendelenburg position: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol. 2025 Feb 7;25(1):61. doi: 10.1186/s12871-025-02933-2.
9.- Szigetváry C, Szabó GV, Dembrovszky F, Ocskay K, Engh MA, Turan C, et al. Individualised positive end-expiratory pressure settings reduce the incidence of postoperative pulmonary complications: a systematic review and meta-analysis. J Clin Med. 2024 Nov 11;13(22):6776. doi: 10.3390/jcm13226776.
10.- Mo J, Wang D, Xiao J, Chen Q, An R, Liu HL. Effects of lung protective ventilation strategies on postoperative pulmonary complications after noncardiac surgery: a network meta-analysis of randomized controlled trials. BMC Anesthesiol. 2024 Sep 28;24(1):346. doi: 10.1186/s12871-024-02737-w.
11.- Gutiérrez MAG, Nieto ORP, Pérez GAS, Martínez DE, Antolinez-Motta JM, Zamarrón-López EI. Ventilación mecánica en el paciente con obesidad. Rev Chil Anest. 2024;53(4). doi: 10.25237/revchilanestv53n4-15.
12.- PROVE Network Investigators; Hemmes SN, Gama de Abreu M, Pelosi P, Schultz MJ. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014 Aug 9;384(9942):495–503. doi: 10.1016/S0140-6736(14)60416-5.
13.- Bluth T, Serpa Neto A, Schultz MJ, Pelosi P, Gama de Abreu M, PROBESE Collaborative Group, et al. Effect of intraoperative high positive end-expiratory pressure with recruitment maneuvers vs low PEEP on postoperative pulmonary complications in obese patients: a randomized clinical trial. JAMA. 2019 Jun 18;321(23):2292–2305. doi: 10.1001/jama.2019.7505.
14.- Li X, Liu H, Wang J, Ni ZL, Liu ZX, Jiao JL, Han Y, Cao JL. Individualized positive end-expiratory pressure on postoperative atelectasis in patients with obesity: a randomized controlled clinical trial. Anesthesiology. 2023 Sep 1;139(3):262–273. doi: 10.1097/ALN.0000000000004603.
15.- Östberg E, Thorisson A, Enlund M, Zetterström H, Hedenstierna G, Edmark L. Positive end-expiratory pressure and postoperative atelectasis: a randomized controlled trial. Anesthesiology. 2019 Oct;131(4):809–817. doi: 10.1097/ALN.0000000000002764.
16.- Östberg E, Larsson A, Wagner P, Eriksson S, Edmark L. Positive end-expiratory pressure and emergence preoxygenation after bariatric surgery: effect on postoperative oxygenation: a randomized controlled trial. Eur J Anaesthesiol. 2025 Jan;42(1):54–63. doi: 10.1097/EJA.0000000000002071.
17.- Yang G, Zhang P, Li L, Wang J, Jiao P, Wang J, Chu Q. Driving pressure-guided ventilation in obese patients undergoing laparoscopic sleeve gastrectomy: a randomized controlled trial. Diabetes Metab Syndr Obes. 2023 May 24;16:1515–1523. doi: 10.2147/DMSO.S405804.
18.- Sun YH, Yang XL, Dong BB, Liu Q. Effect of driving pressure-guided positive end-expiratory pressure on respiratory mechanics and clinical outcomes in surgical patients: a systematic review and meta-analysis of randomized controlled trials. Ann Med. 2025 Dec;57(1):2543978. doi: 10.1080/07853890.2025.2543978.
19.- Pérez Nieto OR, Zamarrón López EI, Guerrero Gutiérrez MA, Deloya Tomás E, Soriano Orozco R, Sánchez Díaz JS, et al. PEEP: dos lados de la misma moneda. Medicina Crítica. 2021;35:34–46. doi: 10.35366/99152.
20.- Fuller BM, Ferguson IT, Mohr NM, Drewry AM, Palmer C, Wessman BT, et al. Lung-protective ventilation initiated in the emergency department (LOV-ED): a quasi-experimental, before-after trial. Ann Emerg Med. 2017 Sep;70(3):406–418.e4. doi: 10.1016/j.annemergmed.2017.01.013.
21.- Ball L, Pelosi P. How I ventilate an obese patient. Crit Care. 2019 May 16;23(1):176. doi: 10.1186/s13054-019-2466-x.
22.- Choi JY, Al-Saedy MA, Carlson B. Positive end-expiratory pressure and postoperative complications in patients with obesity: a review and meta-analysis. Obesity (Silver Spring). 2023 Apr;31(4):955–964. doi: 10.1002/oby.23675.
23.- Meshram T, Dang D, Sharma A, Kumari K, Rathod D, Bhatia P. Effects of intraoperative recruitment maneuver in patients with obesity undergoing laparoscopic surgery: a narrative review. J Anaesthesiol Clin Pharmacol. 2025 Jan-Mar;41(1):26–35. doi: 10.4103/joacp.joacp_397_23.
24.- Gómez-Nieto GM, Nando-Villicaña CC, Achar-Farca T. Cambios fisiológicos provocados por la posición del paciente y el neumoperitoneo en procedimientos laparoscópicos. Rev Mex Cir Endoscop. 2021;22(2):77–83. doi: 10.35366/104405.
25.- Boesing C, Schaefer L, Rocco PRM, Luecke T, Krebs J. Positive end-expiratory pressure optimisation during general anaesthesia in patients with obesity: a narrative review of respiratory and cardiovascular outcomes. Br J Anaesth. 2025 Oct 16;S0007-0912(25)00639-7. doi: 10.1016/j.bja.2025.09.009.
26.- Rajendran P, Karim HMR, Panda CK, Neema PK, Dey S. Preintubation machine-delivered pressure support ventilation with positive end-expiratory pressure versus manual bag-mask ventilation for oxygenation in overweight and obese patients: a randomized pilot study. Cureus. 2023 Sep 13;15(9):e45185. doi: 10.7759/cureus.45185.
27.- Wrigge H, Petroff D, Fernandez-Bustamante A. Pressure for high positive end-expiratory pressure in obese surgical patients is growing. Anesthesiology. 2023 Sep 1;139(3):239–243. doi: 10.1097/ALN.0000000000004665.
28.- Cavalcanti AB, Amato MBP, Serpa-Neto A. The elusive search for “best PEEP” and whether esophageal pressure monitoring helps. JAMA. 2019 Mar 5;321(9):839–841. doi: 10.1001/jama.2019.0267.
29.- Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015 Feb 19;372(8):747–755. doi: 10.1056/NEJMsa1410639.
30.- Silva PL, Rocco PRM. The basics of respiratory mechanics: ventilator-derived parameters. Ann Transl Med. 2018 Oct;6(19):376. doi: 10.21037/atm.2018.06.06.
31.- Regli A, Mahendran R, Fysh ET, Roberts B, Noffsinger B, De Keulenaer BL. Matching positive end-expiratory pressure to intra-abdominal pressure improves oxygenation in a porcine sick lung model of intra-abdominal hypertension. Crit Care. 2012 Oct 26;16(5):R208. doi: 10.1186/cc11840.
How to Cite / Como citar
[1] Flavio Morales Vázquez, Mauricio Rodrigo Ríos Zúñiga, José Heriberto Cuán Díaz, and Iván Uriel Gámez Valdez. 2026. Rol de la PEEP en la prevención de complicaciones pulmonares postoperatorias en pacientes con obesidad: una revisión narrativa. CRITICAL CARE & EMERGENGY MEDICINE 5, (January 2026), 50–58. https://doi.org/10.58281/ccem060126-rev-nar-06
Licencia
© 2025 Critical Care & Emergency Medicine by Ediciones Prado. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) .
The copyrights of the articles published in Critical Care & Emergency Medicine belong to Ediciones Prado. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Critical Care & Emergency Medicine without prior authorization for non-commercial use.
ISSN
2992-6785
eISSN: 2992-6785
DOI: 10.3989/ccem
Indexación
Patrocinadores
