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

Andreas Güldner, Thomas Kiss, Ary Serpa Neto, Sabrine N.T. Hemmes, Jaume Canet, Peter M. Spieth, Patricia R.M. Rocco, Marcus J. Schultz, Paolo Pelosi, Marcelo Gama De Abreu

Research output: Contribution to journalReview ArticleResearchpeer-review

235 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)692-713
Number of pages22
Issue number3
Publication statusPublished - Sep 2015
Externally publishedYes

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