Enhanced Ventilation Strategies in Bariatric Surgery: A Case Report of Flow-Controlled Ventilation in an Extremely Obese Patient Undergoing Robot-Assisted Bariatric Surgery

Intraoperative ventilation in obese patients is challenging, eg, during robot-assisted surgery, where altered respiratory mechanics often require high levels of positive end-expiratory pressure (PEEP) and oxygen. With high intrathoracic pressures, hemodynamic instability may occur, while oxygenation can remain impaired. However, a gap of knowledge exists regarding the efficacy of flow-controlled ventilation (FCV) in patients with extreme obesity undergoing bariatric surgery. We describe an obese patient (body mass index [BMI] 68.6kg/m²) in whom conventional ventilation resulted in impaired oxygenation and respiratory compliance. FCV markedly improved gas exchange. Implementing FCV in high-risk obese patients may enhance gas exchange, limit ventilator-induced lung injury, and minimize hemodynamic compromise.