[Does intraoperative lung-protective ventilation reduce postoperative pulmonary complications?].

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Respiratory Physiology

Background:

• Intraoperative protective ventilation strategies are increasingly recognized for their ability to mitigate postoperative pulmonary complications (PPC).
• Understanding the mechanisms of ventilator-induced lung injury (VILI) is crucial for optimizing mechanical ventilation during surgery.

Purpose of the Study:

• To define and outline methods for predicting PPC.
• To explore factors contributing to VILI, including stress, strain, and driving pressure.
• To review evidence-based mechanical ventilation strategies for preventing PPC.

Main Methods:

• A systematic literature search was conducted using the Medline database.
• Included randomized controlled trials focused on intraoperative mechanical ventilation and patient outcomes.

Main Results:

• Low tidal volumes (VT) and high positive end-expiratory pressure (PEEP), with recruitment maneuvers, can prevent PPC.
• In non-obese patients undergoing abdominal surgery, higher PEEP and recruitment maneuvers improved lung function but risked hemodynamic compromise without reducing PPC, length of stay, or mortality.
• Elevated PEEP leading to increased driving pressure correlated with a higher risk of PPC.

Conclusions:

• Intraoperative VT of 6-8 ml/kg ideal body weight is strongly recommended.
• Specific PEEP level recommendations during surgery are not yet established.
• Increases in PEEP that elevate driving pressure should be avoided to minimize PPC risk.