Lower tidal volumes for everyone: principle or prescription?

Excerpt

As demonstrated by the persuasive essay by Lellouche and Lipes [1] appearing in this issue, an attractive argument can be made for using relatively low tidal volumes in all ventilated patients at risk of ARDS. It is hard to quibble with the intent or rationale—after all, in any given individual, tidal volume is achieved by driving pressure, a key component of the VILI equation. Moreover, no safe threshold for tidal volume has yet been identified in clinical trials of ALI/ARDS management [2], and because targeting lower tidal volumes seems to reduce the incidence of adverse outcomes [3, 4], ‘low’ tidal volumes should be applied to all ventilated patients potentially at risk. Sounds very reasonable—what is there not to like? …