Primary graft dysfunction (PGD) occurs in up to 25 of patients after lung transplantation. One method of reducing the risk of developing PGD is to incorporate a protective ventilation strategy in the donor, as well as after allograft implantation in the recipient, both intraoperatively and during postoperative intensive care management. However, this is not standardised practice. This review describes current approaches to protective mechanical ventilation in thoracic anaesthesia, with specific reference to intraoperative lung transplantation, including low tidal volumes, pressure-controlled versus volume-controlled ventilation, positive end-expiratory pressure and alveolar recruitment manoeuvres. ? 2013 Elsevier Inc.