Episode 211: Ventilatory Challenges in Obesity with Lorenzo Berra and Roberta Santiago

The podcast explores personalized ventilation strategies in the operating room and ICU, particularly for obese patients, given the increasing rates of obesity and its impact on respiratory physiology. Dr. Lorenzo Berra and Dr. Roberta Santiago discuss how fixed PEEP values may be inadequate due to patient variability and dynamic changes during surgery. They define key terms like plateau pressure, driving pressure, pleural pressure, and transpulmonary pressure, emphasizing the importance of driving pressure in assessing lung injury risk. The discussion highlights the need for individualized PEEP titration, considering factors like chest wall compliance and regional ventilation, and the potential use of esophageal manometry and electrical impedance tomography for advanced monitoring. While evidence suggests personalized ventilation reduces atelectasis, the speakers note a lack of trials demonstrating improved long-term outcomes.