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Rebuttal From Dr MacIntyreRebuttal From Dr MacIntyre

Neil MacIntyre, MD, FCCP
Author and Funding Information

From the Duke University Medical Center.

Correspondence to: Neil MacIntyre, MD, FCCP, Duke University Medical Center, Durham, NC 27710; e-mail: neil.macintyre@duke.edu


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflict of interest: Dr MacIntyre has served as a consultant to CareFusion of Yorba Linda, California, since 1985.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):293-294. doi:10.1378/chest.11-1086
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Extract

Lung protection involves both limiting maximal (end inspiratory) and tidal stretch. Because of this, neither pressure assist-control nor volume assist-control ventilation is “perfect.” This is because pressure and volume are inextricably linked, and prioritizing one parameter as the control variable necessarily relinquishes some control of the other. Limiting pressure with pressure-targeted modes clearly limits maximal expansion and excessive tidal pressure/volume swings in the severely injured lung, but the tradeoff is a loss of alveolar ventilation guarantee, and the risk of excessive tidal volume (Vt) increases as respiratory system mechanics improve.

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