Patients with acute lung injury or acute respiratory distress syndrome present many challenges in the perioperative setting. Maintaining oxygenation and hemodynamic stability requires a comprehensive plan for both transport and intraoperative management. Many factors are important to consider when choosing a mechanical ventilation strategy, including tidal volume, ventilation mode, and maintenance of positive end-expiratory pressure. The goals of care include maintenance of lung protective strategies during surgery and avoidance of adverse events during transport. Considerations for ventilation unique to the intraoperative setting and situations requiring use of a transport ventilator or an ICU ventilator are discussed. Overall, providing safe and high-quality perioperative care to a critically ill patient requires communication and collaboration among a multidisciplinary team.
BieryDRMarksJDSchaperaAAutryMSchlobohmRMKatzJA. Factors affecting perioperative pulmonary function in acute respiratory failure. Chest. 1990;98:1455-1462.
2.
HedenstiernaGStrandbergABrismarBLundquistHSvenssonLTokicsL. Functional residual capacity, thoracoabdominal dimensions, and central blood volume during general anesthesia with muscle paralysis and mechanical ventilation. Anesthesiology. 1985; 62:247-254.
3.
BrismarBHedenstiernaGLundquistHStrandbergASvenssonLTokicsL. Pulmonary densities during anesthesia with muscular relaxation: a proposal of atelectasis. Anesthesiology. 1985;62:422-428.
4.
TokicsLHedenstiernaGStrandbergABrismarBLundquistH. Lung collapse and gas exchange during general anesthesia: effects of spontaneous breathing, muscle paralysis, and positive end-expiratory pressure. Anesthesiology. 1987;66:157-167.
5.
SuterPMFairleyHBSchlobohmRM. Shunt, lung volume and perfusion during short periods of ventilation with oxygen. Anesthesiology. 1975;43:617-625.
6.
DominoKBorowecLAlexanderCWilliamsJChenLMarshallC. Influence of isoflurane on hypoxic pulmonary vasoconstriction in dogs. Anesthesiology. 1986;64:423-429.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342:1301-1308.
9.
WolthuisEKChoiGDessingMC. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury. Anesthesiology. 2008;108:46-54.
10.
Pinheiro de OliveiraRHetzelMPdos Anjos SilvaMDallegraveDFriedmanG. Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease. Crit Care. 2010;14:R39.
11.
PetrucciNIacovelliW. Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database Syst Rev. 2007;(3):CD003844. doi:10.1002/14651858.CD003844.pub3.
TusmanGBohmSHSuarez-SipmannFTurchettoE. Alveolar recruitment improves ventilatory efficiency of the lungs during anesthesia. Can J Anaesth. 2004;51:723-727.
15.
BadetMBayleFRichardJGurinC. Comparison of optimal positive end-expiratory pressure and recruitment maneuvers during lung-protective mechanical ventilation in patients with acute lung injury/acute respiratory distress syndrome. Respir Care. 2009;54:847-854.
16.
ConstantinJMJaberSFutierE. Respiratory effects of different recruitment maneuvers in acute respiratory distress syndrome. Crit Care. 2008;12:R50.
17.
BigatelloLMDavignonKRStelfoxHT. Respiratory mechanics and ventilator waveforms in the patient with acute lung injury. Respir Care. 2005;50:235-245.
18.
ChengIWEisnerMDThompsonBTWareLBMatthayMA. Acute effects of tidal volume strategy on hemodynamics, fluid balance, and sedation in acute lung injury. Crit Care Med. 2005;33:63-70.
19.
WiedemannHPWheelerAPBernardGR. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564-2575.
20.
HughesCGWeavindLBanerjeeAMercaldoNDSchildcroutJSPandharipandePP. Intraoperative risk factors for acute respiratory distress syndrome in critically ill patients. Anesth Analg. 2010;111:464-467.
21.
GajicOGropperMAHubmayrRD. Pulmonary edema after transfusion: how to differentiate transfusion-associated circulatory overload from transfusion-related acute lung injury. Crit Care Med. 2006; 34(5 suppl):S109-S113.
22.
FernandezRTrenchsXKlamburgJ. Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial. Intensive Care Med. 2008;34:1487-1491.
23.
PelosiPCrociMCalappiE. The prone positioning during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg. 1995;80:955-960.
24.
TongyooSVilaichoneWRatanaratRPermpikulC. The effect of lateral position on oxygenation in ARDS patients: a pilot study. J Med Assoc Thai. 2006;89(suppl 5):S55-S61.
CeredaMWeissYGDeutschmanCS. The critically ill injured patient. Anesthesiol Clin. 2007;25:13-21.
27.
BachillerPRMcDonoughJMFeldmanJM. Do new anesthesia ventilators deliver small tidal volumes accurately during volume-controlled ventilation?Anesth Analg. 2008;106:1392-1400.
28.
RothschillerJLUejimaTDsidaRMCotCJ. Evaluation of a new operating room ventilator with volume-controlled ventilation: the Ohmeda 7900. Anesth Analg. 1999;88:39-42.
29.
TungADrumMLMorganS. Effect of inspiratory time on tidal volume delivery in anesthesia and intensive care unit ventilators operating in pressure control mode. J Clin Anesth. 2005;17:8-15.
30.
MarksJDSchaperaAKraemerRWKatzJA. Pressure and flow limitations of anesthesia ventilators. Anesthesiology. 1989;71:403-408.
31.
StayerSABentSTCamposCJSkjonsbyBSAndropoulosDB. Comparison of NAD 6000 and Servo 900C ventilators in an infant lung model. Anesth Analg. 2000;90:315-321.
32.
KatzJAKalletRHAlonsoJAMarksJD. Improved flow and pressure capabilities of the Datex-Ohmeda SmartVent anesthesia ventilator. J Clin Anesth. 2000;12:40-47.
33.
JaberSTassauxDSebbaneM. Performance characteristics of five new anesthesia ventilators and four intensive care ventilators in pressure-support mode: a comparative bench study. Anesthesiology. 2006;105:944-952.
34.
SiauCStewartTE. Current role of high frequency oscillatory ventilation and airway pressure release ventilation in acute lung injury and acute respiratory distress syndrome. Clin Chest Med. 2008;29:265-275.
35.
RoseL. Clinical application of ventilator modes: ventilatory strategies for lung protection. Aust Crit Care. 2010;23:71-80.
36.
ChanKPStewartTEMehtaS. High-frequency oscillatory ventilation for adult patients with ARDS. Chest. 2007;131:1907-1916.
37.
PutensenCZechSWriggeH. Long term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med. 2001;164:43-49.
38.
RasanenJCaneRDDownsJB. Airway pressure release ventilation during acute lung injury: a prospective multicenter trial. Crit Care Med. 1991;19:1234-1241.
39.
Navarrete-NavarroPRodriguezAReynoldsN. Acute respiratory distress syndrome among trauma patients: trends in ICU mortality, risk factors, complications and resource utilization. Intensive Care Med. 2001;27:1133-1140.
40.
ImaiYSlutskyAS. High-frequency oscillatory ventilation and ventilator-induced lung injury. Crit Care Med. 2005;33(3 suppl):S129-S134.
41.
FanaraBManzonCBarbotODesmettreTCapellierG. Recommendations for the intra-hospital transport of critically ill patients. Crit Care. 2010;14:R87.
42.
WarrenJFrommREOrrRARotelloLCHorstHM. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004;32:256-262.
43.
ZanettaGRobertDGurinC. Evaluation of ventilators used during transport of ICU patients—a bench study. Intensive Care Med. 2002;28:443-451.
44.
DockeryWKFuttermanCKellerSRSheridanMJAklBF. A comparison of manual and mechanical ventilation during pediatric transport. Crit Care Med. 1999;27:802-806.
45.
NakamuraTFujinoYUchiyamaAMashimoTNishimuraM. Intrahospital transport of critically ill patients using ventilator with patient-triggering function. Chest. 2003;123:159-164.
46.
von GoedeckeAWenzelVHörmannC. Effects of face mask ventilation in apneic patients with a resuscitation ventilator in comparison with a bag-valve-mask. J Emerg Med. 2006;30:63-67.
47.
BlumJMFettermanDMParkPKMorrisMRosenbergAL. A description of intraoperative ventilator management and ventilation strategies in hypoxic patients. Anesth Analg. 2010;110:1616-1622.
48.
BlumJMMaileMParkPK. A description of intraoperative ventilator management in patients with acute lung injury and the use of lung protective ventilation strategies. Anesthesiology. 2011;115:75-82.
