Tóm tắt

Objectives: To provide the most recent evidence and to give an overview of the pathophysiology on ventilator-induced lung injury (VILI) on the patients with noninjured lung, and the mechanical ventilation strategies to prevent postoperative pulmonary complications (PPCs). Recent findings: Evidence has indicated that intraoperative mechanical ventilation is associated with an increased risk of postoperative pulmonary complications (PPCs) in patients with noninjured lungs. Volutrauma, barotrauma, atelectrauma, and biotrauma are the primary mechanisms of VILI during mechanical ventilation. Nonprotective ventilator settings with high tidal volume (Vt) (> 10 - 12 mL/kg), very low level of positive end-expiratory pressure (PEEP < 5 cmH2O), or no PEEP may facilitate a decrease in end-expiratory lung volume (EELV) and atelectasis development and is associated with the degradation of both respiratory mechanics and gas exchange. Accumulating evidence has suggested that a prophylactic multifaceted lung-protective mechanical ventilation strategy including small tidal volume, moderate levels of PEEP, and periodic recruitment maneuvers, even in a population with noninjured lungs, can markedly ameliorate the postoperative outcomes. Conclusion: It is well established that intraoperative lung-protective mechanical ventilation strategy which consists of low Vt (6 - 8 mL/kg of ideal body weight), moderate levels of PEEP (8 - 10 cmH2O), and recruitment maneuvers can improve postoperative outcomes. * Keywords: Ventilator-induced lung injury; Lung-protective mechanical ventilation strategy; Tidal volume; Positive end-expiratory pressure.

Abstract

Objectives: To provide the most recent evidence and to give an overview of the pathophysiology on ventilator-induced lung injury (VILI) on the patients with noninjured lung, and the mechanical ventilation strategies to prevent postoperative pulmonary complications (PPCs). Recent findings: Evidence has indicated that intraoperative mechanical ventilation is associated with an increased risk of postoperative pulmonary complications (PPCs) in patients with noninjured lungs. Volutrauma, barotrauma, atelectrauma, and biotrauma are the primary mechanisms of VILI during mechanical ventilation. Nonprotective ventilator settings with high tidal volume (Vt) (> 10 - 12 mL/kg), very low level of positive end-expiratory pressure (PEEP < 5 cmH2O), or no PEEP may facilitate a decrease in end-expiratory lung volume (EELV) and atelectasis development and is associated with the degradation of both respiratory mechanics and gas exchange. Accumulating evidence has suggested that a prophylactic multifaceted lung-protective mechanical ventilation strategy including small tidal volume, moderate levels of PEEP, and periodic recruitment maneuvers, even in a population with noninjured lungs, can markedly ameliorate the postoperative outcomes. Conclusion: It is well established that intraoperative lung-protective mechanical ventilation strategy which consists of low Vt (6 - 8 mL/kg of ideal body weight), moderate levels of PEEP (8 - 10 cmH2O), and recruitment maneuvers can improve postoperative outcomes. * Keywords: Ventilator-induced lung injury; Lung-protective mechanical ventilation strategy; Tidal volume; Positive end-expiratory pressure.