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Improving lung protective mechanical ventilation: the individualised intraoperative open-lung approach.

Br J Anaesth

February 2025

CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Intensive Care Unit, Hospital Universitario La Princesa, Madrid, Spain.

Despite the maturity and sophistication of anaesthesia workstations, improvements in our understanding of intraoperative mechanical ventilation, and use of less invasive surgical techniques, postoperative pulmonary complications (PPCs) are still a common problem in surgical patients of all ages. PPCs are associated with a higher incidence of perioperative morbidity and mortality, longer hospital stays, and higher healthcare costs. PPCs are strongly associated with anaesthesia-induced atelectasis, which predisposes to lung damage when partially collapsed lungs are subjected to mechanical ventilation.

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Introduction: A main feature of CDH is lung hypoplasia and the related presentation of pulmonary hypertension and cardiac dysfunction. Multiple factors influence pulmonary status after CDH: degree of hypoplasia, ventilator-induced injury, altered growth and development of pulmonary structures, reduced diaphragm function and chest wall abnormalities. The evolution of pulmonary sequela in this population is still unclear.

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Background: This study compared the ventilatory variables and computed tomography (CT) features of patients with coronavirus disease 2019 (COVID-19) versus those of patients with pulmonary non-COVID-19-related acute respiratory distress syndrome (ARDS) during the early phase of ARDS.

Methods: This prospective, observational cohort study of ARDS patients in Taiwan was performed between February 2017 and June 2018 as well as between October 2020 and January 2024. Analysis was performed on clinical characteristics, including consecutive ventilatory variables during the first week after ARDS diagnosis.

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Introduction: One of the most prevalent healthcare-associated infections in the pediatric intensive care unit is ventilator-associated pneumonia (VAP). VAP not only results in prolonged hospital and intensive care unit (ICU) stays but also imposes higher costs on patients and the healthcare system. Therefore, it is essential to implement preventive measures.

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One-lung ventilation is commonly used in lateral open chest surgery; however, it can increase pulmonary vascular resistance, which negatively affects Fontan circulation. Nevertheless, one-lung ventilation has a positive indication in post-Fontan patients. It allows surgery with lateral minimally invasive thoracotomy, which does not require a median sternotomy.

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