Are lung-protective ventilation strategies worth the effort?

Nonphysiological ventilation in healthy lungs induces acute lung injury (ALI). Protective lung ventilation in patients with ALI improves outcome. Protective lung ventilation in noninjured lungs and in the absence of a primary pulmonary insult may initiate ventilation-induced lung injury (VILI), as evidenced by inflammatory markers. VILI has important implications that are remote to the lungs and may be associated with significant morbidity and mortality. Volatile anaesthetics can have a lung-protective effect. Excess fluids may contribute to perioperative lung injury. Anaesthesiologists manage a heterogeneous group of patients in the perioperative period, from patients with healthy lungs and patients with at-risk lungs through to patients with established ALI. More patients are at risk for ALI during surgery than previously thought. Appropriate perioperative management may prevent or ameliorate this lung injury. Although evidence is lacking from randomised controlled trials, applying protective ventilatory strategies seems to be a reasonable approach, based on the current understanding of mechanical ventilation and lung injury.