The Society for Translational Medicine: clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy

Anesthesia for lobectomy in thoracic surgery is a great challenge because it requires single contralateral lung ventilation with collapse of the ipsilateral lung. Collapse of the operated lung and ventilation of the other lung may induce an inflammatory response (1). The ventilated lung is hyperperfused, receiving most of the cardiac output and may be damaged by mechanical ventilation. The collapsed lung is exposed to ischemia, reperfusion injury and shear stress on reexpansion and postresection ventilation. As a result, patients who undergo lobectomy postoperatively may develop compromised lung function. Acute lung injury, reduced lung compliance and hypoxemia and an increase in pro-inflammatory cytokines, all are reported (2-6). The aim of mechanical ventilation during one-lung ventilation is (I) to facilitate carbon dioxide elimination; (II) to maintain oxygenation; and (III) to minimize postoperative lung dysfunction. There have been numerous investigations performed to determine the most appropriate means of mechanical ventilation. In this study we systematically searched the literature and the evidence for each graded recommendation