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Postoperative pulmonary complications (PPCs) following major surgery may have significant effect on the outcome. Atelectasis develops and can persist after surgery in as much as 90% of all patients exposed to general anesthesia. Multiple studies have convincingly demonstrated that moderate levels of Positive End Expiratory Pressure (PEEP), applied ideally as soon as preoxygenation is initiated, may be effective to maintain the end-expiratory lung volume and prevent atelectasis. However, PEEP alone cannot effectively reopen a collapsed lung and the use of recruitment maneuver (transient increase in trans-pulmonary pressure) is required. Low tidal volumes, high PEEP and recruitment maneuvers may have protective effects intraoperatively, but the exact place of each intervention has been defined less clearly. Further studies are warranted in order to define the best protocols for intraoperative mechanical ventilation in different populations of surgical patients.

Recruitment maneuver in intraoperative mechanical ventilation: Possibility to prevent atelectasis open lung concept