Does it matter how I ventilate the patient for the postoperative period?

Much has been written about how to ventilate patients in ICU settings, less on how to optimize one-lung ventilation in the OR. After a twentieth century consecrated to the study of hypoxic pulmonary vasoconstriction, lung-separating devices, and prevention of hypoxemia, the last decades have seen the apparition of publications over lung protection, while maintaining a good oxygenation. The incidence of hypoxemia diminished, due in part at least to the fiber-optic bronchoscope which has become a standard of monitoring and care during one-lung ventilation. Pulmonary complications after one-lung ventilation are still one of the leading causes of postoperative morbidity. The question that rises is how to protect the lung(s) during one-lung ventilation? We know what we should do, but we don’t know really how much to do. Low tidal volumes, low inspired oxygen concentration, recruitment maneuvers, PEEP, low driving pressures, and better anesthetics – these evidence-based recommendations are different from what was said before, opening a new era in one-lung ventilation.