General Anesthesia Closes the Lungs: Keep Them Resting

In patients undergoing high risk surgery, postoperative pulmonary complications (PPCs) are frequent and associated with increased morbidity and mortality (1). Different factors may promote PPCs, including clinical characteristics of the patients, type and duration of surgery, the amount and type of fluids administered, as well as pain control. During anesthesia, we suggest the following intraoperative ventilation settings: low VT (6–8 mL/kg predicted body weight), low plateau pressure (<16 cm H2O), low PEEP (5 cm H2O or lower), low ΔP (<13 cm H2O), low inspiratory oxygen fractions and respiratory rate to maintain adequate gas-exchange, while recruitment manoeuvres should not be used routinely. Physiology is important to better understand the clinical mechanisms and suggest possible therapeutic managements. However, before translating physiological findings to clinical practice, large randomized controlled trials are warranted.