How much positive end expiratory pressure during one lung ventilation? An unresolvable question

In this issue of Minerva Anestesiologica, Battaglini et al.1 presented an elegant narrative review concerning the role of positive end expiratory pressure (PEEP) during thoracic surgery. Initially, the attention is focused on pathophysiological rationale of the use of PEEP on the ventilated lung during one lung ventilation (OLV). Anesthesiologists involved in thoracic surgery are striving continuously to optimize one-lung ventilation (OLV). Recent evidence underlines the importance of low tidal volume (VT) andreduced driving pressure during OLV.2, 3 Along with low VT, correct use of PEEP seems to play a pivotal role in terms of protecting the ventilated lung. The question “how much PEEP in OLV?” remains an open discussion in the field of intraoperative mechanical ventilation. Several studies, mostly comparing two different fixed PEEP levels (low vs high), failed to solve this issue.4, 5 Given so, we should reflect weather we are trying to give a “right answer to a wrong question.”