Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2026.844822
Brazilian Journal of Anesthesiology
Editorial

The paradox of mechanical ventilation: life-saving, injurious, and pro-inflammatory − lung protection during general anesthesia with neuromuscular blockade

Jean-Jacques Rouby, Jean-Michel Constantin

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References

1. Silva-Jr JM, Pereira TS, Falcao LFR, et al. Consensus recommendations on perioperative mechanical ventilation strategies: an evidence-based guideline by the Brazilian Society of Anesthesiology. Braz J Anesthesiol. 2026;76(5):844814.

2. Ibsen B. The anaesthetist’s viewpoint on the treatment of respiratory complications in poliomyelitis during the epidemic in Copenhagen, 1952. Proc R Soc Med. 1954;47:72−4.

3. Reisner-Sen elar L. The birth of intensive care medicine: Björn Ibsen’s records. Intensive Care Med. 2011;37:1084−6.

4. Carteaux G, Spinelli E, Jaber S. Understanding lung physiology through ventilator screen. Intensive Care Med. 2026;52:1537−41.

5. Bendixen HH, Hedley-Whyte J, Laver MB. Impaired oxygenation in surgical patients during general anesthesia with controlled ventilation. A concept of atelectasis. N Engl J Med. 1963;269:991−6.

6. Hedley-Whyte J. Intraabdominal surgery and anesthesia management. Anesthesiology. 2017;126:543−6.

7. Sykes MK, Young WE, Robinson BE. Oxygenation during anaesthesia with controlled ventilation. Br J Anaesth. 1965;37:314−25.

8. Nunn JF, Bergmann NA, Coleman AJ. Factors influencing the arterial oxygen tension during anaesthesia with artificial ventilation. Br J Anaesth. 1965;37:898−914.

9. Visick WD, Fairley HB, Hickey RF. The effects of tidal volume and end-expiratory pressure on pulmonary gas exchange during anesthesia. Anesthesiology. 1973;39:285−90.

10. Dreyfuss D, Basset G, Soler P, Saumon G. Intermittent positivepressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats. Am Rev Respir Dis. 1985;132:880−4.

11. Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis. 1988;137:1159−64.

12. Puybasset L, Cluzel P, Gusman P, Grenier P, Preteux F, Rouby JJ. Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. CT Scan ARDS Study Group. Intensive Care Med. 2000;26:857−69.

13. Rouby JJ, Puybasset L, Nieszkowska A, Lu Q. Acute respiratory distress syndrome: lessons from computed tomography of the whole lung. Crit Care Med. 2003;31(4 Suppl):S285−95.

14. Gattinoni L, Pesenti A. The concept of "baby lung". Intensive Care Med. 2005;31:776−84.

15. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301−8.

16. Terragni PP, Rosboch G, Tealdi A, et al. Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2007;175:160−6.

17. Gattinoni L, Pesenti A, Avalli L, Rossi F, Bombino M. Pressurevolume curve of total respiratory system in acute respiratory failure. Computed tomographic scan study. Am Rev Respir Dis. 1987;136:730−6.

18. Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372:747−55.

19. Neto AS, Hemmes SN, Barbas CS, et al. PROVE Network Investigators. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a metaanalysis of individual patient data. Lancet Respir Med. 2016;4:272−80.

20. Puybasset L, Gusman P, Muller JC, Cluzel P, Coriat P, Rouby JJ. Regional distribution of gas and tissue in acute respiratory distress syndrome. III. Consequences for the effects of positive end-expiratory pressure. CT Scan ARDS Study Group. Adult Respiratory Distress Syndrome. Intensive Care Med. 2000;26:1215−27.

21. Rouby JJ. Lung overinflation. The hidden face of alveolar recruitment. Anesthesiology. 2003;99:2−4.

22. Constantin JM, Grasso S, Chanques G, et al. Lung morphology predicts response to recruitment maneuver in patients with acute respiratory distress syndrome. Crit Care Med. 2010;38:1108−17.

23. Haitsma JJ, Lachmann B. Lung protective ventilation in ARDS: The open lung maneuver. Minerva Anestesiol. 2006;72:117−32.

24. Cavalcanti AB, Suzumura EA, Laranjeira LN, et al. Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2017;318:1335−45.

25. Carvalho AR, Jandre FC, Pino AV, et al. Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury. Crit Care. 2007;11:R86.

26. Constantin JM, Jabaudon M, Lefrant JY, et al. AZUREA Network. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial. Lancet Respir Med. 2019;7:870−80.

27. Brismar B, Hedenstierna G, Lundquist H, Strandberg A, Svensson L, Tokics L. Pulmonary densities during anesthesia with muscular relaxation−a proposal of atelectasis. Anesthesiology. 1985;62:422−8.

28. Rodrigues RR, Sawada AY, Rouby JJ, et al. Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass. Braz J Med Biol Res. 2011;44:598−605.

29. Froese AB, Bryan AC. Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology. 1974;41:242−55.

30. Malbouisson LM, Busch CJ, Puybasset L, Lu Q, Cluzel P, Rouby JJ. Role of the heart in the loss of aeration characterizing lower lobes in acute respiratory distress syndrome. CT Scan ARDS Study Group. Am J Respir Crit Care Med. 2000;161:2005−12.

31. Neves FH, Carmona MJ, Auler Jr JO, Rodrigues RR, Rouby JJ, Malbouisson LM. Cardiac compression of lung lower lobes after coronary artery bypass graft with cardiopulmonary bypass. PLoS One. 2013;8:e78643.

32. Wanderer JP, Blum JM, Ehrenfeld JM. Intraoperative low-tidalvolume ventilation. N Engl J Med. 2013;369:1861.

33. Neto AS, Cardoso SO, Manetta JA, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome a meta-analysis. JAMA. 2012;308:1651−9.

34. Dos Santos CC, Slutsky AS. Invited review: mechanisms of ventilator-induced lung injury: a perspective. J Appl Physiol (1985). 2000;89:1645−55.

35. Tremblay L, Valenza F, Ribeiro SP, Li J, Slutsky AS. Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. J Clin Invest. 1997;99:944−52.

36. Ranieri VM, Suter PM, Tortorella C, et al. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA. 1999;282:54−61.

37. Oliveira PR, Hetzel MP, Silva MA, Dallegrave D, Friedman G. Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease. Crit Care. 2010;14(2):R39.

38. Schilling T, Kozian A, Huth C, et al. The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery. Anesth Analg. 2005;101:957−65.

39. Zupancich E, Paparella D, Turani F, et al. Mechanical ventilation affects inflammatory mediators in patients undergoing cardiopulmonary bypass for cardiac surgery: a randomized clinical trial. J Thorac Cardiovasc Surg. 2005;130:378−83.

40. Futier E, Constantin JM, Paugam-Burtz C, et al. IMPROVE Study Group. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013;369:428−37.

41. Hemmes SNT, Abreu MG, Pelosi P, Schultz M. PROVE Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014;384(9942):495−503.

42. Dorland G, Abreu MG, Hemmes SNT, et al. Writing and Steering Committees for the DESIGNATION−Investigators. Intraoperative Driving Pressure-Guided High PEEP vs Standard Low PEEP for Postoperative Pulmonary Complications. JAMA. 2026;335:693−702.

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