Background: Pulmonary complications are a major cause of postoperative mortality. Many factors can aggravate pulmonary complications. Lung protective ventilation strategy can prevent pulmonary complications to some extent. Objective: To know if lung protective ventilation strategies can improve clinical outcomes of patients with high risk factors. Content: To explain if lung protective ventilation strategies can improve clinical outcomes of patients with high risk factors like smoking, Advanced age, Pulmonary hypertension, COPD, cardiac and neurologic diseases, and so on. Trend：In patients with ARDS, ventilation with low tidal volumes and high level of PEEP are recommended, and intraoperative ventilation should continue the settings applied on the ICU. In other critically ill patients, the evidence for the benefits of low tidal volume ventilation is growing. Low tidal volumes could cause excessive hypercapnia. High level of PEEP could cause dynamic hyperinflation, increased intracranial pressure and increased incidence of hemodynamic instability. So we should not use lung protective ventilation strategies blindly. In patients with comorbidities, further research is necessary to find out whether lung protective ventilation should be adopted.