Lung protective ventilation  - NYSORA

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Lung protective ventilation 

Learning objectives

  • Understand the basic principles behind lung protective ventilation


  • Lung protective ventilation (LPV) is a ventilation strategy aiming to reduce pulmonary complications after mechanical ventilation
  • Perioperative lung injury is a spectrum of disease that includes inflammation, impaired gas exchange, radiographic abnormalities, and respiratory failure
  • It is reasonable to use LPV as the default ventilation strategy in all mechanically ventilated patients

Ventilator settings (management)

  • Tidal volume of 6-8 mL/kg predicted body weight
  • Plateau pressures <30 cm H2O
  • Start positive end-expiratory pressure (PEEP) at 5 cm H2O
  • When performing recruitment maneuvers use:
    • The lowest effective pressure
    • The shortest effective time
    • The least amount of breaths 

Keep in mind

  • Ventilator induced lung injury (VILI) occurs via:
    • Volutrauma: high tidal volumes
    • Barotrauma: high inspiratory pressures
    • Atelectotrauma: repetitive and rapid opening of the alveoli
    • Biotrauma:
      • Inflammatory damage
      • Apoptotic/fibroproliferative processes
      • The translocation of bacteria and pro-inflammatory mediators
  • VILI shares common pathophysiological features with acute respiratory distress syndrome (ARDS)
  • ARDS is caused by:
  • VILI occurs most often in patients with predisposing factors for ARDS
  • In patients at risk for ARDS or with ARDS, LPV;
    • Improves oxygenation and pulmonary physiology
    • Reduces postoperative pulmonary complications
    • Reduces the relative risk of death at day 28 

Suggested reading

  • Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. Br J Anaesth. 2019;123(6):898-913.
  • O’Gara B, Talmor D. Perioperative lung protective ventilation. BMJ. 2018;362:k3030. Published 2018 Sep 10. doi:10.1136/bmj.k3030
  • Beitler JR, Malhotra A, Thompson BT. Ventilator-induced Lung Injury. Clin Chest Med. 2016;37(4):633-646.
  • Petrucci N, De Feo C. Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database Syst Rev. 2013;2013(2):CD003844. Published 2013 Feb 28.

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