Respiratory failure & ventilation
Identifying optimal positive end-expiratory pressure by body mass index does not account for natural physiologic variability in pleural pressure
Authors' conclusion
BMI/3' estimated the mean optimal PEEP as measured by esophageal pressure-based transpulmonary pressure and may serve as a starting point for PEEP in patients with increased BMI. However, this purely anthropometric method fails to capture the individual variability of the chest wall and pleural pressure and most often results in inadequate or excessive PEEP as compared to optimal PEEP based on esophageal manometry.
Study context
- Population
- Patients across a range of body mass indexes (BMIs) undergoing laparoscopic abdominal surgeryincluded for analysis
- Participants
- 109 patients
- Exposure
- 'BMI/3' and positive end-expiratory pressure (PEEP) 10 cmH2O vs optimal physiological PEEP by esophageal manometry
- Outcome
- Estimated PEEP within ±2 cmH2O of optimal physiological PEEP by esophageal pressure-based transpulmonary pressure
Main finding
As reported in the abstract
Estimate within ±2 cmH2O of optimal physiological PEEP
Observational data: associations, not effects.
Further findings
- Mean optimal physiologic PEEP closely approximated by mean 'BMI/3' estimate
- Ranges of individualized optimal PEEP wider than 'BMI/3' estimates across BMI categories
Original publication
Identifying optimal positive end-expiratory pressure by body mass index does not account for natural physiologic variability in pleural pressure. Anaesth Crit Care Pain Med. Published 12 November 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →