Rol de la PEEP en la Prevención de Complicaciones Pulmonares Postoperatorias en pacientes con obesidad: una revisión narrativa

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