• George Márcio Costa Souza, Gianni Mara Santos, Sandra Adriana Zimpel, and Tamara Melnik.
• Universidade Estadual de Ciências da Saúde de Alagoas - Uncisal. Pró-Reitoria de Ensino e Graduação, Rua Jorge de Lima, N 113, Trapiche, Maceió-Al, Maceio, Alagoas, 57010-382, Brazil. georgemarcioft@gmail.com.
• BMC Anesthesiol. 2020 Feb 4; 20 (1): 36.

BackgroundObesity is a global epidemic, and it is widely known that increased Body mass index (BMI) is associated with alterations in respiratory mechanics. Bariatric surgery is established as an effective treatment for this condition.ObjectiveTo assess the safety and effectiveness of different ventilation strategies in obese patients undergoing bariatric surgery.MethodsA systematic review of randomized clinical trials aimed at evaluating ventilation strategies for obese patients was carried out. Primary outcomes: in-hospital mortality, adequacy of gas exchange, and respiration mechanics alterations.ResultsFourteen clinical trials with 574 participants were included. When recruitment maneuvers (RM) vs Positive end-expiratory pressure (PEEP) were compared, RM resulted in better oxygenation p = 0.03 (MD 79.93), higher plateau pressure p < 0.00001 (MD 7.30), higher mean airway pressure p < 0.00001 (MD 6.61), and higher compliance p < 0.00001 (MD 21.00); when comparing RM + Zero end-expiratory pressure (ZEEP) vs RM + PEEP 5 or 10 cmH2O, RM associated with PEEP led to better oxygenation p = 0.001 (MD 167.00); when comparing Continuous Positive Airway Pressure (CPAP) 40 cmH2O + PEEP 10 cmH2O vs CPAP 40 cmH2O + PEEP 15 cmH2O, CPAP 40 + PEEP 15 achieved better gas exchange p = 0.003 (MD 36.00) and compliance p = 0.0003 (MD 3.00).ConclusionThere is some evidence that the alveolar recruitment maneuvers associated with PEEP lead to better oxygenation and higher compliance. There is no evidence of differences between pressure control ventilation (PCV) and Volume control ventilation (VCV).

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