Don't Make Things Worse with Your Ventilator Settings: How You Manage the Lungs During the Perioperative Period Affects Postoperative Outcomes

Nonphysiological ventilation in healthy lungs induces acute lung injury (ALI). Protective lung ventilation in patients with ALI improves outcomes. Protective lung ventilation in noninjured lungs and in the absence of a primary pulmonary insult may initiate ventilator-induced lung injury, as evidenced by inflammatory markers. Ventilator-induced lung injury has important implications remote to the lungs and may be associated with significant morbidity and mortality. Volatile anesthetics may have a lung-protective effect. Excess fluids may contribute to perioperative lung injury. Anesthesiologists 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 severe chronic obstructive pulmonary disease. More patients are at risk for ALI during surgery than previously thought. Appropriate perioperative management may prevent or ameliorate this lung injury.