• Christopher C Young, Erica M Harris, Charles Vacchiano, Stephan Bodnar, Brooks Bukowy, R Ryland D Elliott, Jaclyn Migliarese, Chad Ragains, Brittany Trethewey, Amanda Woodward, Gama de Abreu Marcelo M Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, TU Dresden, , Martin Girard, Emmanuel Futier, Jan P Mulier, Paolo Pelosi, and Juraj Sprung.
• Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA. Electronic address: christopher.young@duke.edu.
• Br J Anaesth. 2019 Dec 1; 123 (6): 898-913.

AbstractPostoperative pulmonary complications (PPCs) occur frequently and are associated with substantial morbidity and mortality. Evidence suggests that reduction of PPCs can be accomplished by using lung-protective ventilation strategies intraoperatively, but a consensus on perioperative management has not been established. We sought to determine recommendations for lung protection for the surgical patient at an international consensus development conference. Seven experts produced 24 questions concerning preoperative assessment and intraoperative mechanical ventilation for patients at risk of developing PPCs. Six researchers assessed the literature using questions as a framework for their review. The modified Delphi method was utilised by a team of experts to produce recommendations and statements from study questions. An expert consensus was reached for 22 recommendations and four statements. The following are the highlights: (i) a dedicated score should be used for preoperative pulmonary risk evaluation; and (ii) an individualised mechanical ventilation may improve the mechanics of breathing and respiratory function, and prevent PPCs. The ventilator should initially be set to a tidal volume of 6-8 ml kg-1 predicted body weight and positive end-expiratory pressure (PEEP) 5 cm H2O. PEEP should be individualised thereafter. When recruitment manoeuvres are performed, the lowest effective pressure and shortest effective time or fewest number of breaths should be used.Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

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