This topic1 is very important for the multidisciplinary team that working with this population of patients in order to know the possible factors associated with the risk of pulmonary complications and determine strategies to minimize these complications. However, we consider that after deep analysis, some key practical issues need proper discussion.

Firstly, although the retrospective design of this study is subject to temporal biases, as well as the assessments are carried out by different team members can also result in some results described, especially for the real short outcome analysis. In this line, we consider appropriate that it could be interesting to evaluate patients only with previous pulmonary alterations and specific pulmonary test evaluations, so it would be possible to determine the objective and definitions of “higher risk” to develop postoperatory atelectasis. Guimarães et al. assess the impact of immediate postextubation use of Boussignac Continuous Positive Airway Pressure (CPAP) on arterial oxygenation in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass. The authors demonstrated application of Boussignac CPAP for 2h after extubation improved oxygenation but did not improve forced expiratory volume at 1s and forced vital capacity.2

Secondly, the authors demonstrate that gender is a risk factor associated with atelectasis in the post-operative period, however, 82.8% of subjects included in the study were female, and this outcome would not be expected? This is not clear answer that has implications for preventive postoperative complications protocols. Baltieri et al. determined what moment of application of positive pressure brings better benefits on lung function, incidence of atelectasis and diaphragmatic excursion, in the preoperative, intraoperative or immediate postoperative period and demonstrated the optimal time of application of positive pressure is in the immediate postoperative period, immediately after extubation, because it reduces the incidence of atelectasis. The predominant gender in the study were female.3

Thirdly, an important point to note in this study was the physical therapy twice a day, which started on the first day after surgery. We previously conducted a randomized clinical trial to evaluate the effect of physical therapy care in the immediate postoperative period in patients undergoing abdominal surgery.4 We showed that physical therapy performed in the immediate postoperative period reduced the loss of lung function, loss of respiratory muscle strength and length of stay in the recovery room.

We believe that, as well as the interesting results of this study, further research to assess complications in the postoperative period and possible associated risk factors should be encouraged.