Ventilatory strategies during anesthesia

Juraj Sprung, Toby N. Weingarten, David O. Warner

Research output: Chapter in Book/Report/Conference proceedingChapter

4 Scopus citations


This chapter discusses respiratory system mechanics and gas exchange during anesthesia of morbidly obese (MO) patients. It describes ventilatory strategies that can improve oxygenation while protecting the lungs from ventilator-induced mechanical stress. After induction of anesthesia, deterioration of partial pressure of arterial oxygen (PaO2) occurs in MO patients. For normal weight and obese patients, prolonged mechanical ventilation with high pressure can induce mechanical stress and acute ventilator-associated lung injury (VALI). PaCO2 is correlated with effective ventilation, and an acute decrease in PaCO2 after recruitment indicates improvement (decrease) of physiologic dead space. The chapter summarizes various peri-operative strategies that provide open-lung ventilation and protect against ventilator-induced lung injury. High tidal volume (VT) without positive end-expiratory pressure (PEEP) during mechanical ventilation may cause subclinical lung injury. For MO patients, a protective ventilatory strategy incorporates prevention of atelectasis and lung overexpansion while using lower end-inspiratory pressure (PEI).

Original languageEnglish (US)
Title of host publicationMorbid Obesity
Subtitle of host publicationPeri-operative Management
PublisherCambridge University Press
Number of pages14
ISBN (Electronic)9780511676307
ISBN (Print)9780521518840
StatePublished - Jan 1 2010

ASJC Scopus subject areas

  • General Medicine


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