Review of the Mechanisms of Ventilator Induced Lung Injury and the Principles of Intraoperative Lung Protective Ventilation.

Intraoperative ventilator induced lung injury is associated with development of postoperative pulmonary complications. Despite advances in modes and methods of mechanical ventilation, postoperative pulmonary complications remain as one of the leading causes of adverse outcomes following surgery and anesthesia. In an attempt to reduce the incidence of postoperative pulmonary complications, the use of an intraoperative ventilatory technique to minimize lung injury has been introduced. Lung protective ventilation typically entails the use of a physiologic tidal volume, positive end expiratory pressure, extended inspiratory time, and an alveolar recruitment maneuver. The goal of intraoperative lung protective ventilation is to prevent or at least minimize development of ventilator induced lung injury by maintaining a homogeneous lung and alveolar stability during and after a surgical procedure. To appreciate the value of the application of an intraoperative lung protective ventilation strategy, the pathophysiology and developmental processes of ventilator induced lung injury must first be understood. The primary purpose of this paper is to provide a basic understanding of the relationship between conventional intraoperative mechanical ventilation, pulmonary derangement and lung injury as well as a rationale for the use of individualized lung protective ventilation to optimize surgical patient pulmonary outcomes.