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Protective Lung Ventilation During General Anesthesia: Is There Any Evidence?

  • Chapter
Annual Update in Intensive Care and Emergency Medicine 2014

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM,volume 2014))

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Abstract

In acute respiratory distress syndrome (ARDS) several studies have shown that mechanical ventilation with high tidal volume (VT) and low levels of positive end-expiratory pressure (PEEP) can promote ventilator-induced lung injury (VILI), thus increasing morbidity and mortality [1]. An open lung strategy, combining the use of low VT with adequate PEEP levels and recruitment maneuvers, has thus been recommended in ARDS patients [2–4]. In patients without ARDS admitted to intensive care units (ICUs), who required mechanical ventilation for at least 12 hours, the use of a high VT significantly increased the inflammatory response [5, 6]. In contrast to critically ill patients, during general anesthesia, mechanical ventilation is required only for a few hours, thus the beneficial effects of lung-protective ventilation remain questionable. Moreover, there are limited data from few randomized controlled trials with only small cohorts of enrolled patients.

Two recent meta-analyses that enrolled patients from ICUs and the operating room (OR) showed that lung-protective ventilation was associated with lower mortality and postoperative complications [2, 7]. However, there are no recommendations regarding optimal ventilatory strategies in patients without lung injury during general anesthesia.

In the present article, we provide a comprehensive picture of the current literature on lung-protective ventilation during general anesthesia in patients without ARDS, focusing on the applications of this strategy in patients undergoing abdominal, thoracic and cardiac surgery.

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Authors and Affiliations

  1. Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan University, Milan, Italy

    S. Coppola, S. Froio & D. Chiumello

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  1. S. Coppola
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  2. S. Froio
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  3. D. Chiumello
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Correspondence to D. Chiumello .

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  1. Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent Prof.

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Coppola, S., Froio, S., Chiumello, D. (2014). Protective Lung Ventilation During General Anesthesia: Is There Any Evidence?. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2014. Annual Update in Intensive Care and Emergency Medicine, vol 2014. Springer, Cham. https://doi.org/10.1007/978-3-319-03746-2_13

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  • DOI: https://doi.org/10.1007/978-3-319-03746-2_13

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-03745-5

  • Online ISBN: 978-3-319-03746-2

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