Search Results (171)

Background and Objectives: Postoperative pulmonary complications (PPCs) remain an important cause of morbidity after cardiac surgery. Driving pressure (DP), defined as the difference between plateau pressure and positive end-expiratory pressure, has been proposed as a bedside marker of respiratory system mechanics during lung-protective ventilation. However, its relationship with PPCs in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) remains uncertain. This study aimed to evaluate the association between intraoperative DP and PPCs following CPB-supported cardiac surgery. Materials and Methods: This single-center prospective observational study included 99 adult patients undergoing elective cardiac surgery with CPB. All patients were ventilated using a standardized lung-protective strategy with a tidal volume of 6 mL/kg predicted body weight and a fixed PEEP of 5 cmH₂O. Patients were categorized according to intraoperative DP as Group I (DP < 13 cmH₂O, n = 66) and Group II (DP ≥ 13 cmH₂O, n = 33). The primary outcome was a composite PPC endpoint, defined as the occurrence of at least one EPCO-defined pulmonary complication during the postoperative hospital stay. Multivariable logistic regression was performed to assess whether pre-CPB DP was independently associated with PPCs after adjustment for body mass index, CPB time, and age. Results: Patients with DP ≥13 cmH₂O had higher post-CPB and ICU-admission lactate concentrations. Pneumothorax, pleural effusion, atelectasis, CPAP requirement, and prolonged mechanical ventilation were more frequent in the elevated-DP group. Mechanical ventilation duration, ICU stay, and hospital stay were also longer in this group. Composite PPCs occurred in 41 patients (41.4%). Although higher pre-CPB DP showed a non-significant trend toward increased PPC risk in univariable analysis (OR 1.121, 95% CI 0.988–1.273; p = 0.077), it was not independently associated with the composite PPC endpoint after adjustment (adjusted OR 1.091, 95% CI 0.952–1.251; p = 0.212). In contrast, higher pre-CPB DP was significantly associated with prolonged postoperative ventilation and longer mechanical ventilation, ICU, and hospital stay durations. Conclusions: Elevated intraoperative DP was associated with a higher unadjusted burden of PPCs and delayed postoperative recovery after CPB-supported cardiac surgery. However, pre-CPB DP was not an independent predictor of the composite PPC endpoint after adjustment for relevant confounders. These findings suggest that DP may serve as a clinically useful marker of impaired respiratory mechanics and postoperative vulnerability rather than as an independent causal determinant of PPCs. Full article

Acute hypoxemic respiratory failure (AHRF) represents one of the most common and clinically challenging indications for invasive mechanical ventilation in the intensive care unit, characterized by profound etiological heterogeneity that demands accurate diagnosis to guide treatment. While clinical history, physical examination, and laboratory data remain essential, they are often insufficient to reliably discriminate among conditions such as acute respiratory distress syndrome (ARDS), cardiogenic pulmonary edema, and pneumonia—particularly in mechanically ventilated patients. Lung imaging has therefore emerged as an indispensable complement to clinical assessment. In this narrative review, we systematically describe the physical principles, clinical applications, and limitations of the imaging modalities currently available in critical care: chest X-ray (CXR), computed tomography (CT), lung ultrasound (LUS), electrical impedance tomography (EIT), and positron emission tomography (PET). CXR remains the most widely used bedside tool but is constrained by low sensitivity and significant interobserver variability. CT is the gold standard for morphological and quantitative lung phenotyping, enabling the assessment of recruitability, baby lung characterization, and the identification of complications, but requires patient transport and exposes patients to ionizing radiation. LUS offers real-time, bedside evaluation of aeration with high diagnostic accuracy for pneumothorax and pleural effusion, and is increasingly integrated into revised ARDS diagnostic criteria. EIT enables continuous, radiation-free monitoring of regional ventilation distribution and positive end-expiratory pressure (PEEP)-guided titration directly at the bedside. While PET provides unparalleled quantification of regional inflammation and ventilation-perfusion mismatch, it currently remains a purely investigative research tool. Finally, we discuss emerging technological and AI-driven advances—including dual-energy CT, next-generation EIT, and deep learning algorithms—that are poised to transform lung imaging from a passive diagnostic tool into an active, personalized guide to respiratory management. Full article

Background/Objectives: Weaning failure from mechanical ventilation affects 10–20% of critically ill patients. Cardiovascular dysfunction—particularly diastolic dysfunction with elevated left atrial pressure (LAP)—underlies up to 50–60% of failed spontaneous breathing trials (SBTs) and frequently remains undetected without targeted echocardiographic assessment. This narrative review synthesises current evidence on the echocardiographic evaluation of weaning failure, with emphasis on LAP estimation, right ventricular (RV) dysfunction, and the integration of lung and diaphragm ultrasound. Methods: A structured literature search of PubMed/MEDLINE and EMBASE was performed for publications from January 2000 to April 2026, supplemented by hand-searching of reference lists and current society guidelines. This article is reported as a narrative review; no formal systematic review protocol was registered. A qualitative synthesis emphasising pathophysiological mechanisms, echocardiographic phenotypes, and clinical applicability was performed. Results: Positive pressure ventilation with PEEP provides active LV afterload reduction; extubation abruptly removes this unloading and may precipitate acute filling pressure elevation in vulnerable patients. Multiparametric echocardiographic LAP assessment—integrating the E/e’ ratio, deceleration time, and pulmonary vein flow—supports pre-extubation risk stratification. The dynamic PEEP reduction test, although not yet standardised or multicentre-validated, may identify patients with load-dependent cardiac decompensation before extubation. RV dysfunction is present in 20–50% of ventilated patients and worsens weaning outcomes through ventricular interdependence. Complementary lung ultrasound B-line quantification and diaphragm thickening fraction assessment together support a phenotype-specific diagnostic approach. Conclusions: A structured multimodal ultrasound framework integrating echocardiography, lung ultrasound, and diaphragm ultrasound may support identification and targeted treatment of the dominant mechanism of weaning failure before extubation. Prospective multicentre validation of the integrated protocol as a whole remains a priority research need. Full article

Background: Obesity increases the risk of postoperative pulmonary complications (PPCs), and active smoking may further amplify this risk. Whether smoking status identifies a subgroup of obese surgical patients with differential PPC risk or a different response to intraoperative Positive End-Expiratory Pressure (PEEP) strategy remains unclear. We evaluated whether smoking status influences PPCs and modifies the effect of intraoperative PEEP strategy in obese patients undergoing surgery. Methods: In this single-center randomized trial, 95 obese surgical patients were assigned to either a low-PEEP strategy (4 cmH₂O without recruitment maneuvers) or a high-PEEP strategy (12 cmH₂O with recruitment maneuvers). The primary endpoint was PPC incidence within 5 postoperative days in the overall randomized population. Smoking status was recorded at baseline, and pre-specified exploratory subgroup analyses assessed PPC incidence according to smoking status and the smoking-by-PEEP interaction. Results: The overall incidence of postoperative pulmonary complications (PPCs) was 8.9% in the low-PEEP group and 8.0% in the high-PEEP group (p > 0.05). Among smokers, complications occurred in 18.2% in the low-PEEP group and 11.8% in the high-PEEP group. For non-smokers, rates were 5.9% and 6.1%, respectively. No statistically significant differences were observed. Conclusions: Active smoking was associated with a numerically higher incidence of PPCs in obese patients; however, this finding was not statistically significant. The high-PEEP strategy with recruitment maneuvers did not reduce PPC incidence compared with the low-PEEP strategy. Trial Registration: Approval number 003208/2016. Full article

Background and Objectives: Patients with obesity undergoing laparoscopic bariatric surgery face elevated perioperative pulmonary risk due to impaired respiratory mechanics, reduced functional residual capacity, and pneumoperitoneum-induced atelectasis. Intraoperative changes in intra-abdominal pressure and surgical positioning substantially alter respiratory mechanics, yet studies evaluating repeated PEEP titration at multiple intraoperative time points remain limited. This study aimed to determine whether dynamic compliance-guided individualized PEEP titration, applied at three distinct intraoperative stages, reduces postoperative pulmonary aeration loss compared to fixed 8 cmH₂O PEEP. Methods: In this single-center randomized controlled trial with blinded outcome assessment, 70 patients with obesity (BMI ≥ 35 kg/m²) undergoing laparoscopic bariatric surgery were randomized 1:1 to the CDYN group (dynamic compliance-guided PEEP titration at T1: post-induction, T2: during pneumoperitoneum, T3: post-deflation; n = 35) or the PEEP8 group (fixed PEEP 8 cmH₂O; n = 35). The primary outcome was the modified lung ultrasound score (mLUSS), assessed 30 min after PACU arrival by a blinded investigator (ClinicalTrials.gov: NCT06994780). Results: Total mLUSS was significantly lower in the CDYN group (2.20 ± 1.16 vs. 5.80 ± 2.14; p < 0.001), with significant differences in both hemithoraces. The PaO₂/FiO₂ ratio at PACU was significantly higher in the CDYN group (425.11 ± 127.13 vs. 311.65 ± 92.59 mmHg; p < 0.001), and the supplemental oxygen requirement was significantly lower (p = 0.001). Dynamic compliance was consistently higher throughout surgery (all p < 0.001) without differences in airway pressures or hemodynamics. Conclusions: Dynamic compliance-guided individualized PEEP titration, applied at three intraoperative stages, significantly reduces early postoperative pulmonary aeration loss and improves oxygenation in patients with obesity undergoing laparoscopic bariatric surgery, without increasing barotrauma risk or hemodynamic instability. Full article

Background and Clinical Significance: COVID-19 may worsen in patients receiving immunosuppressants. Furthermore, drug–drug interactions and concomitant use of anti-inflammatory drugs complicate treatment. We report the clinical course of severe COVID-19 pneumonia in a 74-year-old Japanese male kidney transplant recipient. Case Presentation: The patient had been taking tacrolimus (TAC) (2.5 mg/day), mycophenolate mofetil (1000 mg/day), and prednisone (5 mg/day) since his kidney transplant 7 years earlier. Twenty days before admission, he tested positive for SARS-CoV-2 antigen and was administered molnupiravir for 5 days. At admission, real-time PCR testing of a nasopharyngeal specimen revealed high viral loads, with Ct values of 22.2 and 27.9 for the E and N2 genes, respectively. An oxygen flow rate of 15 L/min was required to maintain arterial oxygen saturation above 90%. TAC was continued, and antibiotics, steroids, anti-interleukin-6 receptor antibodies, intravenous immunoglobulin, and ensitrelvir (ESV) were administered. With invasive positive-pressure ventilation, positive end-expiratory pressure (PEEP), and prone positioning, the arterial oxygen tension/inspired oxygen tension (P/F) improved from 61.3 to 386 within 7 h. The patient was extubated 30 h after admission. The TAC dose was adjusted from 2.5 mg/day to 1 mg/day to achieve the target trough level. The patient was discharged on hospital day 8. PCR testing at discharge showed a decrease in viral load. Conclusions: This study provides insights into the treatment of COVID-19 in patients receiving immunosuppressants. Combination therapy of ESV and TAC was feasible in kidney transplant recipients with dose adjustment. The use of other anti-inflammatory drugs should also be considered. Full article

Sustainable management of peatlands is one of the key global strategies for mitigating climate change. The balance between carbon (C) sequestration and emission in peatlands reflects environmental conditions over time and can provide insight into long-term ecosystem dynamics. However, current methods for estimating greenhouse gas (GHG) fluxes are often labor-intensive, costly, and site-specific. In this study, we propose a simplified and cost-efficient method to estimate long-term carbon balance in peatlands based on the inorganic (mineral) content of drill core samples. The approach uses exponential decay equations to approximate peat accumulation and decomposition processes over time. A conceptual model is applied that accounts for both anaerobic transformation of organic matter of varying molecular complexity and enhanced aerobic decomposition resulting from anthropogenic drainage during the last century. The model was applied to more than 100 drill cores from four peatland systems in Estonia. The resulting trends were compared qualitatively with known climatic fluctuations of the last millennium, including periods associated with the Little Ice Age. The results suggest that, in many cases, carbon losses from decomposition in deeper peat layers may exceed carbon accumulation in upper layers, even in peatlands that appear to be well preserved. The proposed method provides a rapid, low-cost, first-order approximation of peatland carbon dynamics and may serve as a complementary tool for large-scale assessments where detailed process-based models are not feasible. Full article

Background/Objectives: Metabolic and bariatric surgery (MBS) is increasingly performed worldwide and requires specific anesthetic management due to the complex physiological alterations associated with severe obesity. Although several international guidelines provide recommendations for perioperative care in bariatric patients, their implementation in routine clinical practice may vary. This study aimed to report anesthetic practices among Polish anesthesiologists providing anesthesia for bariatric procedures. Methods: A cross-sectional survey study was conducted in October 2025 among Polish anesthesiologists. The questionnaire consisted of 13 closed-ended questions addressing demographic characteristics, anesthetic management and blood pressure management, including preoperative thresholds for postponement of elective surgery and intraoperative thresholds for pharmacological treatment of hypotension. The survey was distributed via social media platforms. Participation was anonymous and voluntary. Results: A total of 71 anesthesiologists participated in the study. The most commonly used intubation device was the Macintosh laryngoscope (57.7%), while videolaryngoscopy was used by 42.2% of respondents. Positive end-expiratory pressure (PEEP) was routinely applied by most respondents, with 63.4% adjusting its level according to patient body weight. Multimodal analgesia components were commonly used, with paracetamol (95.8%), dexamethasone (91.5%), metamizole (90.1%), and lignocaine (84.5%) being the most frequently administered drugs. Most anesthesiologists reported postponing elective surgery when blood pressure exceeded 180/110 mmHg. More experienced anesthesiologists more often considered lower thresholds for postponement of elective surgery (p = 0.006). Conclusions: Reported practices among surveyed anesthesiologists for MBS in Poland are generally consistent with international recommendations, particularly regarding the use of PEEP. However, variability remains in airway management strategies and the use of videolaryngoscopy, highlighting the need for continued education and broader implementation of evidence-based perioperative protocols. Full article

Background: The optimal intraoperative positive end-expiratory pressure (PEEP) obtained by titrating to the lowest tolerable fraction of inspired oxygen (FiO₂) has been proposed recently; however, whether its performance in obtaining optimal PEEP is comparable to that from electrical impedance tomography (EIT) titration remains unknown. Methods: Ninety-three adult patients undergoing robotic-assisted laparoscopic prostatectomy under general anesthesia were enrolled in this study. They underwent the determination of optimal PEEP obtained either by titrating to the lowest tolerable FiO₂ (PEEP_O2) or using EIT (PEEP_EIT). The primary endpoint was intraoperative optimal PEEP values. Secondary endpoints included pre-extubation arterial oxygen partial pressure (PaO₂)/FiO₂, intraoperative mean arterial blood pressure (MAP), the incidence of hypoxemia in the postanesthesia care unit (PACU), and postoperative pulmonary complications (PPCs) up to discharge from hospital. Results: Group PEEP_O2 (n = 47) exhibited a higher optimal PEEP compared to Group PEEP_EIT (n = 46) [Median (IQR): 18 (16–18 cmH₂O) vs. 16 (14–16 cmH₂O), p < 0.001]. Pre-extubation PaO₂/FiO₂ was higher in Group PEEP_O2 (510.5 ± 80.0 vs. 471.8 ± 69.0 mmHg, p = 0.015), while lung dynamic compliance (41.1 ± 7.7 vs. 37.3 ± 6.4 mL cmH₂O⁻¹, p = 0.011) and static compliance (36.4 ± 5.8 vs. 33.6 ± 5.5 mL cmH₂O⁻¹, p = 0.017) were also higher in Group PEEP_O2. Additionally, driving pressure (11.0 ± 2.0 vs. 12.1 ± 1.9 cmH₂O, p = 0.006) was lower in Group PEEP_O2. There were no significant differences in intraoperative MAP and the incidences of PACU hypoxemia and PPCs between the two groups. Conclusions: The optimal PEEP obtained by titrating to the lowest tolerable FiO₂ is a clinically acceptable alternative of that obtained using EIT. Therefore, this technique could be a viable alternative to EIT for obtaining optimal PEEP. Full article

Background/Objectives: Mechanical ventilation (MV) is a crucial intervention in managing severe respiratory failure due to COVID-19. However, its use may be complicated by pulmonary barotrauma, a serious event associated with increased morbidity and mortality. Understanding its incidence and associated risk factors is essential for optimising ventilatory strategies and improving patient outcomes. The aim of this study was to determine the incidence and risk factors associated with the development of pulmonary barotrauma in mechanically ventilated patients with COVID-19. Methods: All mechanically ventilated patients aged 18 years and above who were admitted to the COVID-19 Intensive Care Unit (ICU) from January 2021 to June 2022 were included. Patients who developed pulmonary barotrauma prior to or within 24 h of ICU admission, had iatrogenic pneumothorax, were readmitted to the ICU, or were ventilated for causes other than COVID-19-related respiratory failure were excluded. Data on patient demographics, vaccination status, ventilator parameters, laboratory findings, and the use of steroid or immunomodulatory therapies were collected and analysed. Univariate and multivariate logistic regression analyses were performed to identify the potential risk factors and clinical outcomes associated with pulmonary barotrauma. Results: The medical records of 204 patients were included. The incidence of pulmonary barotrauma was 22.5%. Lower C-reactive protein (CRP) levels at ICU admission, lower FiO₂ requirements during the first week of MV, a higher positive end-expiratory pressure (PEEP) during the second week, and a prolonged mechanical ventilation duration were significantly associated with pulmonary barotrauma (p = 0.039, 0.049, 0.021, and 0.036, respectively). Patients who developed pulmonary barotrauma experienced longer ICU stays (p = 0.006) and higher all-cause ICU mortality (p = 0.009). Conclusions: Lower CRP levels and a lower FiO₂ requirements, a higher PEEP use, and longer ventilator days were the independent risk factors for pulmonary barotrauma in our study population, leading to a longer ICU stay and higher all-cause ICU mortality. Full article

Background: Thoracentesis is pivotal in managing pleural effusion (PE), particularly in invasive mechanical ventilation (IMV), with documented improvements in respiratory mechanics, oxygenation, and hemodynamic parameters. However, its efficacy may vary based on effusion type and drained volume. Methods: A retrospective longitudinal study was conducted at a high-complexity care center in Cali, Colombia (2019–2024), including 93 (IMV) patients who underwent therapeutic thoracentesis (TT). Respiratory and hemodynamic parameters were assessed before and up to 24 h post-procedure. Stratified analysis was performed by drained volume, fluid type, and left ventricular ejection fraction (LVEF). Results: TT yielded significant improvements in fraction of inspired oxygen (FiO₂) (−4%), positive end expiratory pressure (PEEP) (−0.5 cmH₂O), and Oxygen arterial Pressure Index/Inspired Oxygen Fraction (PaO₂/FiO₂-ratio) (+27.1), with greater impact for volumes ≥500 mL and transudative PE. Patients with LVEF ≤ 40% showed increased mean arterial pressure (MAP) and PaO₂. Complication rates were low (<4%). Conclusions: TT is safe and effective in critically ill IMV patients, particularly for transudative PE and drained volumes ≥500 mL, as well as in subjects with LVEF ≤ 40%. Its positive impact on oxygenation and ventilation supports its therapeutic utility in critical care. Full article

Face recognition technology implemented on blockchain platforms enhances the security and integrity of face embeddings (the numerical representations extracted from facial images). However, it encounters unique privacy challenges due to the transparent and immutable nature of blockchains. Face embeddings hold sensitive biometric data that, once compromised, cannot be changed like conventional passwords. This study offers a new framework for using the Internet Computer Protocol (ICP), a decentralized blockchain platform, to implement CosPEEPChain (blockchain-secured privacy-preserving face recognition using eigenface perturbation and CosFace). CosPEEPChain integrates eigenface decomposition with local differential privacy (LDP) to ensure the privacy of face embeddings, CosFace for cosine margin learning’s discriminative ability on perturbed eigenface representations, and blockchain to ensure transparent and tamper-proof storage of face recognition models. We present CosPEEP (privacy-preserving face recognition using eigenface perturbation and CosFace), which shows substantial improvements and maintains consistent performance over baseline PEEP (privacy using eigenface perturbation), with a mean accuracy of 96.77 ± 0.85% and stability (std = 0.31–1.28%) across a range of privacy budgets ($ϵ\in [0.5,8.0]$) on the LFW dataset. Statistical significance testing confirms CosPEEP surpasses PEEP in 11/16 privacy budgets (p < 0.05) with a mean improvement of +1.92%. We also present ArcPEEP, which uses additive angular margin loss (ArcFace) to compare margin-based improvements. We verify the attributes of the models on the chain. In total, CosPEEPChain uses fewer cycles compared to the baseline ICP face recognition. Full article

Background/Objectives: Positive end-expiratory pressure (PEEP) is a standardized component of the invasive mechanical ventilation (IMV) settings to improve oxygenation; however, its physiological effects in patients with no documented prior lung disease remain poorly defined. This study evaluated the impact of moderate PEEP variations on macrohemodynamic parameters, gas exchange, and driving pressure (ΔP). Methods: This single-arm, non-randomized, crossover study included adult intensive care unit (ICU) patients with no documented prior lung disease during the early phase of IMV. Sequential PEEP levels of 6, 8, and 10 cmH₂O were applied for 30 min each within the first 24 h of ICU admission, while all other ventilatory parameters were kept constant. Arterial blood gases [partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂), and arterial oxygen saturation (SaO₂)], oxygenation index [PaO₂/fraction of inspired oxygen (FiO₂)], systolic, diastolic, and mean arterial pressures, ΔP, and static compliance (Cstat) were measured. Friedman and Mann–Whitney U tests were used, with adjustment for multiple comparisons. Results: A total of 150 patients were enrolled (64.7% male). The observed mortality rate was 53.3%; however, mortality was not defined as a primary or secondary outcome, and was used only as a grouping variable for comparative analyses. Intraindividual comparison across PEEP levels of 6, 8, and 10 cmH₂O showed small but significant reductions in systolic and mean arterial pressure at higher PEEP (p-value < 0.05), with Bonferroni-adjusted significance for PEEP 6 vs. 10. No significant differences were observed in oxygenation (SaO₂, PaO₂, and PaO₂/FiO₂), PaCO₂, ΔP, or Cstat. These results suggest that moderate PEEP changes produced limited macrohemodynamic effects without relevant impact on gas exchange or respiratory mechanics. Overall, no clinically relevant or statistically significant differences were observed in gas exchange, macrohemodynamic parameters, ΔP, or Cstat across PEEP levels when mortality was used as the grouping variable. Among survivors, higher PEEP was associated with modest reductions in systolic and mean arterial pressures and higher PaCO₂ values; however, these findings did not translate into consistent physiological benefits. Conclusions: In mechanically ventilated patients with no documented prior lung disease, PEEP may exert divergent effects on macrohemodynamics, gas exchange, and ΔP, supporting a cautious and individualized approach to PEEP selection in this population. Full article

Objectives: Diuretics are frequently used in bronchopulmonary dysplasia (BPD), yet evidence describing their short-term physiological effects remains limited. This study aimed to describe early changes in respiratory support parameters and safety outcomes following combined oral spironolactone and hydrochlorothiazide (SP/HCTZ) therapy in preterm infants with BPD. Methods: A retrospective, single-center before–after observational study was conducted. Preterm infants diagnosed with BPD who initiated SP/HCTZ therapy were included. Respiratory parameters (FiO₂, PEEP, and flow rate) and serum electrolytes were compared between Day 1 (initiation) and Day 3 of treatment. A predefined clinical response was defined as either a ≥10% reduction in FiO₂ or a step-down in respiratory support modality. Results: Fifty-six infants (mean gestational age 27.7 ± 2.3 weeks) were analyzed. After 72 h of SP/HCTZ therapy, mean FiO₂ decreased from 26.2 ± 6.3% to 22.4 ± 3.4% (p < 0.001). Significant reductions were also observed in PEEP and cannula flow rates (p = 0.004 and p = 0.003, respectively). Overall, 39 infants (69.6%) met the predefined clinical response criteria. The prevalence of hyponatremia (Na < 133 mmol/L) increased from 7.1% at baseline to 25.0% on Day 3 (p = 0.039). Conclusions: Initiation of SP/HCTZ was temporally associated with short-term reductions in respiratory support parameters; however, these findings should be interpreted as associations rather than treatment effects. Given the increased frequency of hyponatremia by Day 3, close electrolyte monitoring appears warranted during the early phase of therapy. Full article

Background: Navigational bronchoscopy (NB) enables precise sampling of peripheral and central pulmonary nodules using shape-sensing or electromagnetic guidance. A major challenge is anesthesia-induced atelectasis, which alters lung anatomy, reduces registration accuracy, and is known to lower diagnostic accuracy. To counteract this, ventilatory protocols such as the Ventilatory Strategy to Prevent Atelectasis (VESPA) and the Lung Navigation Ventilation Protocol (LNVP) have been recommended. Their adoption and clinical impact, however, remain uncertain. Methods: We conducted a retrospective review of 224 consecutive NB procedures performed under general anesthesia at a single academic medical center (January 2020–August 2024). Demographic, anesthetic, and ventilatory data were extracted from electronic records. Outcomes included navigational success (ability to reach the lesion) and diagnostic accuracy (concordance between bronchoscopic diagnosis and final clinical diagnosis after follow-up). Ventilatory practices were compared with published VESPA and LNVP recommendations. Results: Navigational success, defined as successful advancement of the bronchoscope to the target lesion with tissue acquisition, was achieved in 89.2% of cases. Overall diagnostic accuracy, defined as concordance between bronchoscopic diagnosis and final clinical diagnosis after follow-up, was 81.7%. Ventilatory management consistently diverged from recommended protocols. Most patients were ventilated with FiO₂ > 0.6, PEEP in the range of 7–10 cm H₂O, and tidal volumes of 300–500 mL. The only recommended maneuver systematically applied was recruitment immediately after intubation. Despite widespread deviation from both VESPA and LNVP, diagnostic performance remained favorable relative to published benchmarks. No major anesthesia-related complications occurred. Conclusions: In this retrospective series, navigational success comparable to published studies that adapted strict ventilation protocols was achieved with also comparable diagnostic accuracy without strict adherence to predefined ventilatory strategies. Recruitment maneuvers may represent the most influential component of current protocols, but institutional factors such as procedural expertise and case volume likely contributed to outcomes. Prospective studies are warranted to determine whether standardized ventilatory protocols are necessary for optimizing NB performance. Full article