More than 230 million surgical procedures are undertaken each year worldwide¹. Many of these patients receive general anaesthesia with its attendant mechanical ventilation, which exposes them to the potential risk of postoperative pulmonary complications. Although results from research conducted on this topic are inconclusive, evidence gained over the past few years suggests the use of lung protection strategies for surgical patients despite the fact that not all questions have been sufficiently answered.

This article 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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There is an increasing call for protective ventilation during anaesthesia. We stay tuned to the latest developments and current literature on this topic. In addition, our whitepaper provides even more background information in accordance with the scientific literature.

Protective ventilation in the OR creates significant demands on the anaesthesia workstation. In the following, further materials / contents will be made available, which can help to assess the topic or provide added value.

1. Weiser, TG, Regenbogen, SE, Thompson, KD et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008; 372: 139–144
2. Serpa Neto, A, Schultz, MJ, Slutsky, AS. Current concepts of protective ventilation during general anaesthesia. Swiss Med Wkly. 2015;145 :w14211
3. Pelosi P, Ball L. Intraoperative mechanical ventilation in patients with non-injured lungs: time to talk about tailored protective ventilation? Ann Transl Med 2016 Jan;4(1):17