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In September 2025, authors Audrey De Jong 🇫🇷, Samir Jaber 🇺🇸, and Maximilian Schaefer 🇩🇪 published an editorial in Intensive Care Medicine highlighting the key principles and recent advances that underpin best practices in respiratory support for postoperative patients in the intensive care unit (ICU), summarized below:

🫁 Key Principles

An intraoperative lung-protective strategy consisting of low tidal volumes (VT), low PEEP, and recruitment maneuvers reduces postoperative pulmonary and extrapulmonary complications in intermediate- to high-risk patients undergoing major abdominal surgery.

In contrast, studies testing different PEEP levels (with or without recruitment maneuvers) while keeping tidal volume constant, or different tidal volumes at constant PEEP, did not demonstrate a reduction in pulmonary complications.

The success of intraoperative ventilation strategies depends on their effect on the driving pressure (P. plateau - PEEP).

⚙️ Recent Developments

During the transition of mechanically ventilated patients from the operating room to the ICU, ventilator adjustments that increased mechanical power were associated with a higher risk of mortality.

Heterogeneous ventilation patterns observed via electrical impedance tomography at ICU admission were associated with postoperative pulmonary complications (PPCs) and a longer ICU stay.

Complications such as post-extubation desaturation and hypotension were substantially lower when extubation was performed in the recovery room.

💨 Noninvasive Respiratory Support

Noninvasive ventilation (NIV) should be applied after extubation, particularly in obese patients, to prevent reintubation.

High-flow nasal oxygen (HFNO) therapy helps reduce complications after thoracic surgery with one-lung ventilation.

👉🏼 Additionally, the article also addresses postoperative patient mobilization.

😉 Read the full article here:
Key principles and recent developments for ventilatory management of the surgical critically ill patient

🧐 And you — how do you manage your postoperative patients to prevent respiratory complications?