Cardiopulmonary bypass (CPB), which induces pulmonary injury, significantly impacts the quality of life in patients undergoing cardiac surgery. Preventing and treating pulmonary complications has become a critical clinical issue. Optimizing ventilation strategies during the preoperative, intraoperative, and postoperative stages is essential for adequate lung protection and preventing CPB-related pulmonary injury.

A comprehensive search of multiple databases including PubMed, Embase, and the Cochrane Library was conducted. After removing the duplicate studies, full-text review was performed, and all studies that reported mechanical ventilation strategies and lung protection during CPB were included.

This review systematically examines ventilation strategies during CPB, outlining optimized parameters and pharmacologic approaches across pre-, intra-, and post-CPB phases to reduce lung injury. Various modes — including volume control ventilation (VCV), pressure control ventilation (PCV), and pressure-controlled ventilation–volume guaranteed (PCV-VG) — demonstrate unique benefits and limitations. When combined with protective measures (low tidal volume [LTV], moderate positive end-expiratory pressure [PEEP], and recruitment maneuvers), they show clinical efficacy in lung protection. Pharmacologic agents like ambroxol, neutrophil elastase inhibitors, and sivelestat further enhance protection, underscoring the promise of combined mechanical-pharmacological strategies against CPB-induced lung injury.

A comprehensive approach integrating individualized ventilation management and pharmacological intervention is key to reducing CPB-induced lung injury, enhancing postoperative respiratory function, and improving patient outcomes.