Recommendations for Mechanical Ventilation During General Anesthesia for Trauma Surgery

Purpose of Review: Mechanical ventilation is an essential part of anesthesia for trauma surgery, but there are few recommendations for intraoperative ventilator management. This review examines the limited evidence for intraoperative ventilator practices during trauma surgery Recent Findings: Most recommendations for surgical ventilator management are derived from ICU guidelines, but trauma surgery includes considerations not always present in the ICU. During trauma surgery, normoxia or mild hypoxia should be maintained. Permissive hypercapnia may be beneficial in the absence of metabolic acidosis, but priority should be given to maintaining a pH > 7.25. Tidal volumes of 4–8 mL/kg·IBW are possible but difficult when age, height, and weight cannot be measured accurately. A pressure-limited strategy has some potential benefits and should be considered. Summary: Mechanical ventilation is almost ubiquitous during trauma surgery, but there is only limited research into optimal ventilator settings. Evidence supports limiting tidal volumes and driving pressures during surgery.