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This study compared three protective ventilation strategies with a postoperative partial pressure of oxygen (PaO<jats:sub>2<\/jats:sub>)\/fraction of inspired oxygen (FiO<jats:sub>2<\/jats:sub>) ratio to reduce the incidence of immediate postoperative pulmonary complications (PPCs) in patients undergoing lung resection surgery. Eighty-seven patients with ASA physical status I\u2013III requiring OLV for lung resection surgery were randomized into three groups according to the applied ventilation strategies: low tidal volume (V<jats:sub>T<\/jats:sub>) of 4\u00a0mL\/kg of predicted body weight (PBW) (LV group), medium V<jats:sub>T<\/jats:sub> of 6\u00a0mL\/kg of PBW (MV group), and high V<jats:sub>T<\/jats:sub> of 8\u00a0mL\/kg of PBW (HV group). All patients received 5 cmH<jats:sub>2<\/jats:sub>O of positive end-expiratory pressure (PEEP). The primary outcome was the mean difference of PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> ratio after surgery. The radiologic findings of acute lung injuries were also evaluated. The incidence of immediate PPCs was determined by PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> ratio of\u2009&lt;\u2009300\u00a0mmHg and\/or newly developed radiological findings within 72\u00a0h after surgery. The MV group showed the highest PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> ratio at 6\u00a0h postoperatively (<jats:italic>P<\/jats:italic>\u2009=\u20090.010). There were no significant among-group differences in radiological findings in 3 postoperative days. The MV group showed the lowest incidence of immediate PPCs among the three groups (<jats:italic>P<\/jats:italic>\u2009=\u20090.007). During OLV in lung resection surgery, protective ventilation at a V<jats:sub>T<\/jats:sub> of 6\u00a0mL\/kg with PEEP of 5 cmH<jats:sub>2<\/jats:sub>O may achieve a higher postoperative PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> ratio, reducing the incidence of immediate PPCs.<\/jats:p>","DOI":"10.1007\/s13304-025-02091-7","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T16:45:18Z","timestamp":1737477918000},"page":"925-935","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["An optimal protective ventilation strategy in lung resection surgery: a prospective, single-center, three-arm randomized controlled trial"],"prefix":"10.1007","volume":"77","author":[{"given":"Seihee","family":"Min","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susie","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Woo","family":"Choe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haesun","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong-Hwa","family":"Seo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Hyon","family":"Bahk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,21]]},"reference":[{"key":"2091_CR1","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1016\/S2213-2600(14)70228-0","volume":"2","author":"A Serpa Neto","year":"2014","unstructured":"Serpa Neto A, Hemmes SN, Barbas CS, Beiderlinden M, Fernandez-Bustamante A, Futier E, Hollmann MW, Jaber S, Kozian A, Licker M, Lin WQ, Moine P, Scavonetto F, Schilling T, Selmo G, Severgnini P, Sprung J, Treschan T, Unzueta C, Weingarten TN, Wolthuis EK, Wrigge H, Gama de Abreu M, Pelosi P, Schultz MJ, Network PROVE, investigators (2014) Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: a systematic review and meta-analysis. 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The authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the Institutional Review Board (IRB approval No. 1705\u2013089-855, July 7, 2017) of Seoul National University Hospital (Seoul, Korea) and registered at  (NCT03234621; principal investigator: Jae-Hyon Bahk; date of registration: July 12, 2017). This study was conducted according to the Good Clinical Practice guidelines and principles of the Declaration of Helsinki, as revised in 2013.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent was obtained from all the participants.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}]}}