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Anesthesiology. 2015 Sep;123(3):692-713. doi: 10.1097/ALN.0000000000000754.

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.

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From the Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany (A.G., T.K., P.M.S., M.G.d.A.); Program of Post-Graduation, Research and Innovation; Faculdade de Medicina do ABC (FMABC), and Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.S.N.); Department of Intensive Care Medicine and the Laboratory for Experimental Intensive Care and Anesthesiology, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands (S.N.T.H., M.J.S.); Department of Anesthesiology and Postoperative Care Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain (J.C.); Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (P.R.M.R.); and IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) AOU (Azienda Ospedaliera Universitaria) San Martino IST (Istituto Tumori) Hospital, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy (P.P.). All authors are members of the Protective Ventilation Network (PROVEnet,


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.

[Indexed for MEDLINE]

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