[Intraoperative ventilatory strategy in cardiac surgery: towards a multimodal approach]

Cardiac surgery with or without cardiopulmonary bypass (CPB) remains associated to respiratory morbidity. The underlying mechanisms are multiple. Perioperative application of specific ventilatory strategies allows to limit the lung disturbances. The limitation of the inspired fraction, assisted ventilation controlled with low tidal volume, maintenance of ventilation during CPB and finally, a maneuver of vital capacity are the main components of respiratory management. Thus, to be fully effective, these strategies should be integrated into a multimodal approach starting from the induction and followed until ICU.