Mechanical Protective Ventilation: New Paradigms in Thoracic Surgery.

One-lung ventilation (OLV) in thoracic anesthesia poses dual challenges: preventing hypoxemia and minimizing ventilator-associated lung injury (VALI). Advances such as fiberoptic bronchoscopy and improved anesthetic techniques have reduced hypoxemia, yet optimal management strategies remain uncertain. Protective ventilation, involving low tidal volumes (4-6 mL/kg), individualized PEEP, and selective alveolar recruitment maneuvers (ARM), seek to balance oxygenation and lung protection. However, questions persist regarding the ideal application of PEEP and ARM, as well as their integration into clinical practice. As for PEEP and ARM, further research is needed to address key questions and establish new guidelines.