AFTER many years and much research in the field of intraoperative mechanical ventilation, optimal ventilation strategies to prevent postoperative pulmonary complications remain poorly defined. During general anesthesia for surgery, use of higher inspiratory oxygen fraction, neuromuscular blocking agents, and increased intra-abdominal pressure, due to patient positioning, laparoscopic procedure, or patient characteristics, most commonly obesity, favor the formation of atelectasis. Lung recruitment maneuvers combined with positive end-expiratory pressure (PEEP) may revert atelectasis and stabilize lung units, a strategy that is usually combined with protective low tidal volumes and known as an “open-lung ventilation strategy,” that is, a strategy aimed at recruiting as much lung tissue as possible for tidal ventilation. This strategy is claimed to truly treat the cause of hypoxemia that may result from atelectasis, while preventing cyclic closing and opening of lung units, or...

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