[WAKWiN minireview: intraoperative ventilation and postoperative pulmonary complications-Current evidence and...

Approximately 5% of patients undergoing surgery under general anesthesia suffer from postoperative pulmonary complications. In 20% of these cases, the patients die within the first 30 days after surgery. While ensuring pulmonary gas exchange under general anesthesia, intraoperative mechanical ventilation itself may substantially contribute to the development of ventilator-induced lung injury. Based on approaches used in the treatment of acute respiratory distress syndrome, various intraoperative ventilation strategies have been developed to prevent postoperative pulmonary complications. While neither a high positive end-expiratory pressure nor an individualization of the driving pressure has so far been shown to consistently reduce postoperative pulmonary complications in either one-lung or two-lung ventilation, a beneficial effect appears to emerge in selected surgical procedures and high-risk patients. Newer pathophysiological concepts such as mechanical power (or intensity) may help to optimize ventilation and reduce complications in the future. This review article provides a concise summary of the pathogenesis of ventilator-induced lung injury and discusses the most recently available evidence as well as the potential of current ventilation strategies for lung protection.