Protect the lungs during abdominal surgery: it may change the postoperative outcome.

1254 June 2013 A FTER 2 decades of military dictatorship, in 1985 a civilian president was elected in Brazil. The events surrounding the inauguration related as much to the disciplines of perioperative medicine as to diplomacy. After abdominal surgery, the elected president developed a most significant postoperative pulmonary complication: severe acute respiratory distress syndrome (ARDS). He never took office. Pulmonary complications such as pneumonia, bronchospasm, effusion, failure to wean, and postextubation respiratory failure are leading causes of postoperative complications, second only to wound infection. Severe postoperative pulmonary complications resulting in reintubation and subsequent unplanned intensive care unit admission translate to a more than 90-fold increase in mortality risk.1 As a consequence, it is imperative to improve our understanding of the problem and investigate methods to minimize it. In this issue of AnESTHESIology, Severgnini et al.2 report on important new data implying an association between intraoperative mechanical ventilation strategy and postoperative pulmonary complications in patients undergoing moderate/large abdominal surgery. Stimulated by previous findings in intensive care3,4 and preliminary intraoperative results,5 the authors investigated the effect of a protective ventilatory strategy against what they called “standard ventilation” during abdominal surgery. The main conclusion is that the application of a protective ventilatory strategy with physiological tidal volumes and high positive end-expiratory pressure (PEEP) during abdominal surgery lasting more than 2 h improved respiratory function and reduced a clinical pulmonary infection score in the days after surgery, even if it did not affect length of hospital stay.