Garutti I, et al. - By performing this secondary analysis of a prospective, multicentre, four-arm, randomised controlled trial, named the individualised PeRioperative Open-lung approach Versus standard protectivE ventilation in abdominal surgery study, researchers examined the link of neuromuscular blockade management (reversal) with postoperative pulmonary complications (PPCs). Patients (age more than 18 years) scheduled for major abdominal surgery lasting more than 2 h and exhibiting an intermediate-to-high risk for PPCs were included. Cases with pregnancy or breastfeeding, and moderate-to-severe organ diseases were dismissed. The development of PPCs was documented in patients who were older with a higher BMI, a lower preoperative SpO₂, a higher ASA physical status score and a higher incidence of arterial hypertension, diabetes mellitus or chronic obstructive pulmonary disease. A lower incidence of PPCs related to pharmacological neuromuscular blockade reversal was also reported. In this study sample of patients with intermediate-to-high risk, undergoing abdominal surgery, the independent risk for the development of PPCs was conferred by the spontaneous recovery of neuromuscular blockade. The inclusion of this factor in future investigations on PPCs is recommended.