title: [Does intraoperative lung-protective ventilation reduce postoperative pulmonary complications?].
abstract: BACKGROUND
  Recent studies show that intraoperative protective ventilation is able to reduce postoperative pulmonary complications (PPC).
  
  
  OBJECTIVE
  This article provides an overview of the definition and ways to predict PPC. We present different factors that lead to ventilator-induced lung injury and explain the concepts of stress and strain as well as driving pressure. Different strategies of mechanical ventilation to avoid PPC are discussed in light of clinical evidence.
  
  
  METHODS
  The Medline database was used to selectively search for randomized controlled trials dealing with intraoperative mechanical ventilation and outcomes.
  
  
  RESULTS
  Low tidal volumes (VT) and high levels of positive end-expiratory pressure (PEEP), combined with recruitment maneuvers, are able to prevent PPC. Non-obese patients undergoing open abdominal surgery show better lung function with the use of higher PEEP levels and recruitment maneuvers, however such strategy can lead to hemodynamic impairment, while not reducing the incidence of PPC, hospital length of stay and mortality. An increase in the level of PEEP that results in an increase in driving pressure is associated with a greater risk of PPC.
  
  
  CONCLUSIONS
  The use of intraoperative VT ranging from 6 to 8 ml/kg based on ideal body weight is strongly recommended. Currently, a recommendation regarding the level of PEEP during surgery is not possible. However, a PEEP increase that leads to a rise in driving pressure should be avoided.
authors.affiliation: Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Kiss
authors.affiliation: Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Bluth
authors.affiliation: Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland. mgabreu@uniklinikum-dresden.de.
authors.forename: M
authors.initials: M
authors.lastname: Gama de Abreu
mesh_terms: D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008171:Lung Diseases / Q000453:epidemiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000379:methods*
keywords: Positive endexpiratory pressure; Postoperative pulmonary complications; Protective ventilation; Recruitment maneuver; Tidal volume