Improving lung protective mechanical ventilation: the individualised intraoperative open-lung approach

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Pulmonary Medicine

Background:

• Postoperative pulmonary complications (PPCs) are frequent despite advances in anesthesia and surgery.
• PPCs increase patient morbidity, mortality, hospital stays, and healthcare costs.
• Anesthesia-induced atelectasis is a key factor contributing to PPCs.

Discussion:

• Lung protective ventilation strategies aim to mitigate PPCs.
• Two main hypotheses exist: reducing tidal volume/pressure with minimal PEEP, or actively resolving atelectasis with lung recruitment and individualized PEEP (open-lung approach).
• The individualized open-lung approach actively addresses atelectasis, unlike strategies that tolerate lung collapse.

Key Insights:

• Atelectasis during anesthesia can lead to lung damage during mechanical ventilation.
• Lung protective ventilation is a modifiable factor to reduce PPCs.
• The individualized open-lung approach represents a promising strategy for preventing PPCs.

Outlook:

• Further research is needed to fully understand the benefits and optimal application of the individualized open-lung approach.
• Personalized lung protective ventilation strategies are proposed.
• The goal is to reduce the incidence of PPCs and improve patient outcomes.