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October 27, 2025Current Opinion in Anaesthesiology

Intraoperative mechanical ventilation during thoracic surgery: contemporary controversies and evolving strategies

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Authors

JWJakob WittensteinFPFederico PiccioniCVCaroline M. Vanpeteghem

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Overview

Recent evidence shows individualized PEEP may reduce postoperative pulmonary complications in thoracic surgery, indicating new strategies like therapy bundles are needed.

Key Points

  • To synthesize recent evidence on intraoperative mechanical ventilation strategies during thoracic surgery and their impact on postoperative outcomes.
  • Review of recent randomized controlled trials and meta-analyses.
  • Comparison of fixed versus individualized PEEP strategies.
  • Evaluation of driving pressure, mechanical and chemical power, and therapy bundles.
  • Individualized PEEP titration reduces postoperative pulmonary complications compared to fixed PEEP.
  • High PEEP may increase hemodynamic risk, while low PEEP can lead to atelectasis.
  • Driving pressure is a modifiable risk factor, with reduction linked to improved outcomes.

Cite This Study

Wittenstein et al. (2025) studied this question.

synapsesocial.com/papers/69254f92c0ce034ddc359b6dhttps://doi.org/10.1097/aco.0000000000001587
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Tailored single-lung ventilation approaches and postoperative pulmonary outcomes in thoracic surgery2025 · 13 citations
  2. 2“Tailored” vs. “one-size-fits-all”: current knowledge of individualized PEEP and constant PEEP strategy during the perioperative period2025 · 2 citations
  3. 3“Tailored” vs. “one-size-fits-all”: current knowledge of individualized PEEP and constant PEEP strategy during the perioperative period2025
  4. 4Interpreting individualised positive end‐expiratory pressure2026
  5. 5The search for the missing link between better physiology and patient outcomes2026 · 1 citations