Least Injurious Mechanical Ventilation in Pulmonary Resection Surgery

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In a prospective observational cohort study, Amar et al1 examined the relationship between intraoperative “protective lung ventilation” (defined as mean tidal volume per case <8 mL/kg predicted body weight) and development of postoperative pulmonary complications in patients undergoing lung resection surgery. There are certain points of interest to be discussed:
Understanding of lung heterogeneity, “RV–lung interactions” and pathophysiology of “atelectrauma” and recruitment/derecruitment is key to the development of a “least damaging” intraoperative ventilation bundle (low tidal volume, optimal PEEP, alveolar recruitment maneuvers, “safe” ΔP) that may improve pulmonary morbidity in this high-risk patient population.

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