The article below explores the current discussion on intraoperative lung protective ventilation strategies. The literature reviewed focuses the discussion on the following ventilator settings and parameters: tidal volume (VT), use of positive end-expiratory pressure (PEEP) and applied oxygen fraction (FiO2) as well as recruitment manoeuvres and plateau/driving pressures. Many studies discuss the effects of tidal volume ranges on the lungs during intraoperative ventilation. These trials have suggested that lung protective strategies encompassing reduced VT have a positive effect on the incidence of PPCs2. This is, however, not a standard of care in the operating theatre at present. On the other hand, the use and benefit of PEEP still appear to be controversial. At the moment an optimal PEEP remains to be defined; the discussion currently tends toward moderate to low PEEP3. In addition, titrated approaches are being suggested in order to adapt PEEP and recruitment manoeuvres to the individual patient. Regarding FiO2, it was assumed in the past that a high inspired oxygen fraction would improve oxygenation and reduce postoperative nausea and vomiting (PONV) as well as prevent surgical site infections: Today, this perception seems to have changed1.
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