Intraoperative PEEP Individualization: From Basic to Advanced Techniques

Purpose of Review: Postoperative pulmonary complications (PPCs) are the second most common surgical complications, pose significant challenges, with reported incidences ranging from 5 to 33% and mortality rates up to 30% within 30 days. Lung-protective ventilation, with strategies such as low tidal volume ventilation and judicious PEEP application, has emerged as a cornerstone approach. However, determining the optimal PEEP remains debatable, with fixed PEEP strategies failing to consider individual patient variability. By examining various methodologies for PEEP optimization, the aim is to highlight the benefits and challenges associated with personalized ventilatory strategies in surgical settings. Recent Findings: Several studies underscore the importance of tailoring PEEP settings to individual patient physiology. Techniques such as compliance-guided PEEP, driving pressure optimization, lung ultrasound (LUS), electrical impedance tomography (EIT), and esophageal pressure (Pes) monitoring have shown promise in enhancing intraoperative oxygenation and reducing PPCs.