LAUSR

Acute respiratory distress syndrome (ARDS) in the perioperative setting is an exceedingly rare but catastrophic complication with high mortality. Although mortality is lower than that seen in the general ARDS population, mortality rates still likely exceed 20%. Hence, there has been a significant effort to study the syndrome in the perioperative domain. Despite this significant inquiry, the identification of patients at risk remains an obstacle to progress and prevention. Multiple efforts have been pursued in an attempt to identify patients at risk for postoperative ARDS. As the entity is rare, the ability to study the syndrome prospectively is exceptionally challenging in the general population. Most works that have attempted to identify at-risk patients have used large retrospective data sets or clinically collected cohorts. There have been some works that have conducted studies prospectively targeting at-risk populations. Because of limited data, it becomes difficult to determine whether lungprotective ventilation (LPV) in the operating room (OR) has a substantive impact on the development of ARDS. However, the development of ARDS is not the only reason to consider the use of LPV in the OR. There is substantial evidence to suggest that LPV use is protective in the development of postoperative pulmonary complications (PPC) and other complications. This manuscript attempts to describe the current state of the evidence for LPV and deliver guidance on the basis of these data and expert opinion.