Intraoperative Protective Mechanical Ventilation for Prevention of Postoperative Pulmonary Complications: A Comprehensive Review of the Role of Tidal Volume, Positive End-expiratory Pressure, and Lung Recruitment Maneuvers

• Published in: Anesthesiology (Philadelphia) Vol. 123; no. 3; pp. 692 - 713
• Main Authors: Güldner, Andreas, Kiss, Thomas, Serpa Neto, Ary, Hemmes, Sabrine N T, Canet, Jaume, Spieth, Peter M, Rocco, Patricia R M, Schultz, Marcus J, Pelosi, Paolo, Gama de Abreu, Marcelo
• Format: Journal Article
• Language: English
• Published: United States Copyright by , the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc 01.09.2015
• Subjects: Animals; Humans; Intraoperative Care - methods; Lung - physiology; Positive-Pressure Respiration - methods; Postoperative Complications - prevention & control; Respiration, Artificial - adverse effects; Respiration, Artificial - methods; Tidal Volume - physiology; Ventilator-Induced Lung Injury - prevention & control
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0000000000000754

Postoperative pulmonary complications are associated with increased morbidity, length of hospital stay, and mortality after major surgery. Intraoperative lung-protective mechanical ventilation has the potential to reduce the incidence of postoperative pulmonary complications. This review discusses the relevant literature on definition and methods to predict the occurrence of postoperative pulmonary complication, the pathophysiology of ventilator-induced lung injury with emphasis on the noninjured lung, and protective ventilation strategies, including the respective roles of tidal volumes, positive end-expiratory pressure, and recruitment maneuvers. The authors propose an algorithm for protective intraoperative mechanical ventilation based on evidence from recent randomized controlled trials.