Consensus recommendations on perioperative mechanical ventilation strategies: an evidence-based guideline by the Brazilian society of anesthesiology.

Authors

João Manoel Silva, Talison Silas Pereira, Luiz Fernando Dos Reis Falcão, Ricardo Esper Treml, Alexandre Marini Isola, Alexandre Goulart Pustilnik, Anacleto Gabriel de Alcântara, André Prato Schmidt, Antonio Carlos Aguiar Brandão, Arthur Caus de Morais, Bruna Silveira Ferreira Klauck, Bruno Campostrini Sily, Bruno Francisco de Freitas Tonelotto, Carlos Gustavo Dos Santos Silva, Carmen Sílvia Valente Barbas, Claudia Marquez Simões, Daniel da Escóssia Melo Sousa, Fábio Barlem Hohmann, Fábio Luis Ferrari Regatieri, Germano Pinheiro Medeiros, Gutenberg Diniz Borborema, Maisa Ribeiro de Araújo, Marcelo Ramalho Fernandes, Marcelo Tabary de Oliveira Carlucci, Matheus Faccini Vane, Neymar Elias de Oliveira, Plínio da Cunha Leal, Roberta Figueiredo Vieira, Rodrigo Leal Alves, Rodrigo Pereira Diaz André, Saullo Queiroz Silveira, Victor Sampaio de Almeida, Vinícius Caldeira Quintão, Leandro Gobbo Braz, Luiz Marcelo Sá Malbouisson

Published in

Brazilian journal of anesthesiology (Elsevier). Pages 844814. Aug 18, 2026. Epub Aug 18, 2026.

Abstract

Postoperative Pulmonary Complications (PPCs) are a leading cause of morbidity, mortality, and prolonged hospitalization in surgical patients. Intraoperative mechanical ventilation plays a critical role in mitigating these risks, yet clinical practices remain heterogeneous and often not guided by evidence-based standards.
To develop evidence-based recommendations on perioperative mechanical ventilation strategies for surgical patients, aiming to optimize respiratory care, reduce PPCs, and standardize practice in Brazil.
This guideline was developed under the coordination of the Brazilian Society of Anesthesiology (SBA) by a panel of anesthesiologists and intensivists from multiple institutions. Seventeen clinical questions were structured in the PICO format (Population, Intervention, Comparison, Outcome). Systematic literature searches were conducted in PubMed, Embase, Cochrane Library, and Scopus up to July 2025. The strength of recommendations and certainty of evidence were assessed using the GRADE methodology. A modified Delphi process was applied to obtain agreement among collaborators, and consensus was discussed only when the predefined threshold of at least 80% agreement was not achieved. All recommendations were standardized in a uniform format.
Seventeen thematic chapters were developed, covering topics from respiratory physiology and the definition of PPCs to advanced intraoperative monitoring, special populations (obese, pediatric, thoracic and cardiac surgery), and patients with or without acute lung injury. Key recommendations include the routine use of lung-protective strategies (low tidal volumes 6-8 mL.kg^-1 Predicted Body Weight [PBW]., Positive End-Expiratory Pressure [PEEP]. titrated to physiology, driving pressure ΔP ≤ 15 cm H₂O, and Plateau Pressure [Pplat]. < 30 cm H₂O), individualized approaches in high-risk patients, avoidance of unnecessary high fraction of inspired oxygen (FiO₂), and selective use of recruitment maneuvers. Standardized definitions of PPCs and structured monitoring were emphasized as essential to improving patient outcomes.
These consensus-based recommendations provide clinicians with a practical, evidence-informed framework for perioperative mechanical ventilation. Adoption of protective strategies and standardized definitions is expected to improve respiratory outcomes and reduce variability in perioperative care.

PMID:
42612906
Bibliographic data and abstract were imported from PubMed on 19 Aug 2026.

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