Consensus recommendations on perioperative mechanical ventilation strategies: an evidence-based guideline by the Brazilian Society of Anesthesiology

Résumé fourni par la source

Background Postoperative Pulmonary Complications (PPCs) are a leading cause of morbidity, mortality, and prolonged hospitalization in surgical patients. Intraoperative mechanical ventilation plays a critical role in mitigating these risks, yet clinical practices remain heterogeneous and often not guided by evidence-based standards. Objective To develop evidence-based recommendations on perioperative mechanical ventilation strategies for surgical patients, aiming to optimize respiratory care, reduce PPCs, and standardize practice in Brazil. Methods This guideline was developed under the coordination of the Brazilian Society of Anesthesiology (SBA) by a panel of anesthesiologists and intensivists from multiple institutions. Seventeen clinical questions were structured in the PICO format (Population, Intervention, Comparison, Outcome). Systematic literature searches were conducted in PubMed, Embase, Cochrane Library, and Scopus up to July 2025. The strength of recommendations and certainty of evidence were assessed using the GRADE methodology. A modified Delphi process was applied to obtain agreement among collaborators, and consensus was discussed only when the predefined threshold of at least 80% agreement was not achieved. All recommendations were standardized in a uniform format. Results Seventeen thematic chapters were developed, covering topics from respiratory physiology and the definition of PPCs to advanced intraoperative monitoring, special populations (obese, pediatric, thoracic and cardiac surgery), and patients with or without acute lung injury. Key recommendations include the routine use of lung-protective strategies (low tidal volumes 6–8 mL.kg -1 Predicted Body Weight [PBW]., Positive End-Expiratory Pressure [PEEP]. titrated to physiology, driving pressure ΔP ≤ 15 cm H 2 O, and Plateau Pressure [Pplat]. < 30 cm H 2 O), individualized approaches in high-risk patients, avoidance of unnecessary high fraction of inspired oxygen (FiO 2 ), and selective use of recruitment maneuvers. Standardized definitions of PPCs and structured monitoring were emphasized as essential to improving patient outcomes. Conclusion These consensus-based recommendations provide clinicians with a practical, evidence-informed framework for perioperative mechanical ventilation. Adoption of protective strategies and standardized definitions is expected to improve respiratory outcomes and reduce variability in perioperative care.

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