Objective To explore the ideal ventilation strategy for obese patients undergoing laparoscopic sleeve gastrectomy (LSG).

Methods Data of obese patients undergoing LSG from January 1, 2012 to January 31, 2017 in Huashan Hospital, Fudan University were retrospectively collected from the hospital DoCare system. According to the mean tidal volume (V_T) relative to the ideal body weight (IBW), the patients were divided into three groups: low V_T group (average V_T < 10 mL/kg IBW), medium V_T group (average V_T 10-12 mL/kg IBW) and high V_T group (average V_T > 12 mL/kg IBW). The general data, peak airway pressure (Ppeak), positive end-expiratory pressure (PEEP), oxygenation index (OI), pulmonary dynamic compliance (Cdyn) during pneumoperitoneum and postoperative respiratory complications were compared among the three groups.

Results A total of 81 patients were included, of which 97.5% (79/81) patients were ventilated with pressure-controlled ventilation (PCV) mode and 64.2% (52/81) patients received V_T ≥10 mL/kg IBW during pneumoperitoneum. Compared with the low V_T group, the Cdyn in the middle V_T group and the high V_T group increased significantly, and the Ppeak and OI in the high V_T group increased significantly (P < 0.01). There was no significant difference in PEEP, extubation time and postoperative pulmonary complications among the three groups.

Conclusions Compared with V_T < 10 mL/kg IBW and V_T > 12 mL/kg IBW, obese patients receiving LSG with V_T 10-12 mL/kg IBW had better lung compliance and no significant increase in airway pressure, which could be used as a ventilation strategy for this kind of surgery.