Ventilación protectora y maniobras de reclutamiento pulmonar en cirugía mayor

Mechanical ventilation is a common intervention during surgical procedures, especially in major surgery and critically ill patients. However, it involves exposure to certain risks and has potentially lethal complications. Studies carried out in the last few years have been aimed at defining the ventilatory approach that offers the best safety profile during major surgery. This review attempts to present the available evidence on protective ventilation and recruitment manoeuvres during major surgery. A structured search was performed in MEDLINE and SciELO databases. Some authors agree that the use of low tidal volumes reduces postoperative pulmonary complications. There is conflicting evidence of this benefit in thoracic surgery. There are mixed findings regarding the use of positive end-expiratory pressure. There are suggestions in the literature that this strategy has potential benefits in thoracic, cardiovascular, and trauma surgery, but there is conflicting data for major abdominal surgery and neurosurgery, suggesting the need for further research. Additionally, it still needs to be determined whether recruitment manoeuvres offer real benefits, regardless of the type of surgery. Finally, it is still not possible to establish if protective ventilation or recruitment manoeuvres performed during surgery have an impact on long-term outcomes, such as mortality.