Positive end-expiratory pressure in surgery: Good or bad?

摘要

A key challenge in perioperative care is to reduce postoperative morbidity.1 Patients who develop postoperative pulmonary complications but survive to leave hospital, typically have reduced functional independence and shortened long-term survival. Mechanical ventilation is an example of how we might shift from treatment to prevention of postoperative complications. Stimulated by findings in patients with acute respiratory distress syndrome, a multicentre randomised trial (IMPROVE) of intraoperative lung-protective ventilation was undertaken, using a strategy that consisted of a low tidal volume, moderate positive end-expiratory pressure of 6-8 cm H2O, and repeated recruitment manoeuvres. Improved postoperative outcomes were recorded with protective ventilation compared with non-protective ventilation.