J Anesth Perioper Med. 2015;2(1):45-47. https://doi.org/10.24015/ebcmed.japm.2015.0007

Lung-Protective Ventilation Strategy in Surgical Patients: Optimal Setting of Positive End-Expiratory Pressure?

Fu-Shan Xue, Xu Liao, Rui-Ping Li, and Xin-Long Cui

From the Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Correspondence to Dr. Fu-shan Xue at xuefushan@aliyun.com or fushan.xue@gmail.com.

EBCMED ID: ebcmed.japm.2015.0007 DOI: 10.24015/ebcmed.japm.2015.0007


With regard to optimal PEEP setting of lung-protective ventilation for surgical patients, however, two recent studies provided the inconsistent results. In The Lancet, an international multicentre randomized controlled trial (PROVHILO trial) by The PROVE Network Investigators comparing the ventilation strategies in the patients at risk of PPCs after open abdominal surgery showed that compared with a strategy with a low level of PEEP (≤2 cm H2O) without recruitment manoeuvres, a strategy with a high level of PEEP (12 cm H2O) and recruitment manoeuvres did not protect against PPCs. Thus, the PROVHILO trial concluded that an intraoperative lung-protective ventilation strategy should include a low VT and low PEEP (≤2 cm H2O). However, in a retrospective single-centre study of 29,343 patients receiving mechanical ventilation and undergoing general noncardiac surgeries under general anesthesia, Levin and his colleagues showed that use of VT in the range applied in the PROVHILO trial published by The Lancet and minimum levels of PEEP (median=4 cm H2O) were associated with an increase in 30-day mortality and prolongation of hospital stay.

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Declaration of Interests
None of the authors received financial support and there are no potential conflicts of interest for this work.

All authors have seen and approved the manuscript.

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