RESPIRATION AND THE AIRWAY Lung protective strategies in anaesthesia

Key points † Mechanical ventilation can have adverse effects on pulmonary function by several distinct mechanisms. † Patients undergoing one-lung ventilation or cardiopulmonary bypass are at increased risk of developing acute lung injury (ALI). † Protective ventilatory strategies may prevent or reduce ALI. † There is a lack of randomized controlled trials to guide optimal intra-operative ventilation. Summary. Patients are at risk for several types of lung injury in the perioperative period including atelectasis, pneumonia, pneumothorax, acute lung injury, and acute respiratory distress syndrome. Anaesthetic management can cause, exacerbate, or ameliorate these injuries. This review examines the effects of perioperative mechanical ventilation and its role in ventilator-induced lung injury. Lung protective ventilatory strategies to specific clinical situations such as cardiopulmonary bypass and one-lung ventilation along with newer novel lung protective strategies are discussed.