RESPIRATORY SYSTEM: Edited by Giacomo BellaniMechanical ventilation of the healthy lungs: lessons learned from recent trialsSimonis, Fabienne D.a; Juffermans, Nicole P.b,c; Schultz, Marcus J.a,b,d,eAuthor Information aDepartment of Intensive Care bLaboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Center cOLVG Hospital, Amsterdam, The Netherlands dMahidol University, Bangkok, Thailand eUniversity of Oxford, Oxford, UK Correspondence to Nicole P. Juffermans, MD, PhD, Amsterdam UMC Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail: [email protected] Current Opinion in Critical Care: February 2021 - Volume 27 - Issue 1 - p 55-59 doi: 10.1097/MCC.0000000000000787 Buy Metrics Abstract Purpose of review Although there is clear evidence for benefit of protective ventilation settings [including low tidal volume and higher positive end-expiratory pressure (PEEP)] in patients with acute respiratory distress syndrome (ARDS), it is less clear what the optimal mechanical ventilation settings are for patients with healthy lungs. Recent findings Use of low tidal volume during operative ventilation decreases postoperative pulmonary complications (PPC). In the critically ill patients with healthy lungs, use of low tidal volume is as effective as intermediate tidal volume. Use of higher PEEP during operative ventilation does not decrease PPCs, whereas hypotension occurred more often compared with use of lower PEEP. In the critically ill patients with healthy lungs, there are conflicting data regarding the use of a higher PEEP, which may depend on recruitability of lung parts. There are limited data suggesting that higher driving pressures because of higher PEEP contribute to PPCs. Lastly, use of hyperoxia does not consistently decrease postoperative infections, whereas it seems to increase PPCs compared with conservative oxygen strategies. Summary In patients with healthy lungs, data indicate that low tidal volume but not higher PEEP is beneficial. Thereby, ventilation strategies differ from those in ARDS patients. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.