Laparoscopy, a minimally invasive surgery, has been commonly applied to treat a variety of abdominal diseases. The process of this technique essentially requires pneumoperitoneum and mechanical ventilation, both increase risk of postoperative pulmonary complications(PPCs). PPCs pose serious impact on the prognosis of patients. Therefore,better respiratory management is of great importance to reduce the risk of PPCs.

To discuss the adverse effects of pneumoperitoneum and mechanical ventilation on pulmonary function and currently available strategies for the ventilation management.

Inappropriate settings for mechanical ventilation causes ventilator-induced lung injury (VILI). In addition to skeletal muscle relaxant, general anesthesia further relaxes respiratory muscles, and commonly leads to atelectasis. Pneumoperitoneum is constructed by filling carbon dioxide into abdominal cavity to provide adequate space for laparoscopy. This process restricts pulmonary inflation and respiration. Additionally, carbon dioxide can penetrate into the blood, adversely affecting cardiovascular system. To avoid VILI, protective pulmonary ventilation is recommended. It provides low tidal volume to prevent overexpansion of aveoli, maintains medium positive end expiratory pressure(PEEP) to obtainproperopening sizes of aveoli, and applies intermittent pulmonary re-extension to recruit more aveoli. This strategy reduces the incidence of postoperative crisis that requires mechanical ventilation.

Further investigations are warranted to optimize protective pulmonary ventilation, and to clarify whether protective pulmonary ventilation is beneficial to patients′ long-term prognosis.

Mechanical ventilation; Pneumoperitoneum; Lung protection