Toward lung protective ventilation during general anesthesia: a new challenge.

As Editor-in Chief of Minerva Anestesiologica, the Italian journal devoted to the anesthesiology and critical and intensive care, I wish to congratulate the Revista Española de Anestesiología y Reanimación in its 60 years of dedication to the development of our common medical speciality. We are grateful to be invited to contribute to this celebration. Lung protective mechanical ventilation refers to the use of low tidal volume (tV) and positive end-expiratory pressure (PEEP) with or without the use of recruitment maneuvers. It has been demonstrated to reduce mortality among patients with the Acute Respiratory Distress Syndrome (ARDS) and currently is considered best practice in the care of critically ill patients. General anesthesia is known to be associated with impairment in lung function, in terms of alterations in respiratory system mechanics and in ventilation/perfusion ratio, promoting the onset of lung atelectasis. The development of atelectasis is very common during general anesthesia and is involved in the pathogenesis of many postoperative pulmonary complications such as Ventilator Induced Lung Injury (VILI), pneumonia and postoperative respiratory failure. Unfortunately up to now few randomized controlled trials on lung protective ventilation have been conducted during general anesthesia. Recently two meta-analyses have been published and, even considering the limits of the enrolled studies, have demonstrated that lung protective ventilation