Individualized lung protective ventilation for mechanical ventilation during anesthesia

IBW: ideal body weight; PEEP: positive end expiratory pressure; FiO₂: fraction of inspired oxygen; SpO₂: oxygen saturation; DP: driving pressure; CRS: respiratory system compliance; TPP: transpulmonary pressure; Vt: tidal volume; BMI: body mass index; ASA: American Society of Anesthesiologists; OSA: obstructive sleep apnea.
* DP = Plateau pressure – PEEP.
¶ CRS = Vt/DP. Changes in CRS can be monitored by using pressure volume loops on the anesthesia ventilator; decreased CRS results in rightward rotation of the loop.
Δ Examples of high risk conditions include worsening hypoxemia, age >50 years, BMI >40 kg/m², ASA physical status >2, OSA, preoperative anemia, emergency or urgent surgery, ventilation duration >2 hours, sepsis, abdominal, thoracic, or cardiac surgery.
◊ Increase PEEP in small increments (eg, 2 cm H₂O), and wait at least 30 to 60 seconds before reassessing DP and CRS. Monitor closely for hemodynamic effects when increasing PEEP. Continue ventilation with the level of PEEP that achieves the lowest DP and best CRS.