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Editorials: POINT/COUNTERPOINT EDITORIALS |

Point: Is Low Tidal Volume Mechanical Ventilation Preferred for All Patients on Ventilation? YesLow Tidal Volume Mechanical Ventilation Point

Rolf D. Hubmayr, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Department of Physiology and Biomedical Engineering, Mayo Clinic.

Correspondence to: Rolf D. Hubmayr, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: rhubmayr@mayo.edu


Funding/Support: Dr Hubmayr receives grants from the Mayo Clinic and the National Institutes of Health [RO1 HL63178] in support of his research on mechanical ventilation-associated lung injury.

Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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(1):9-11. doi:10.1378/chest.11-0825
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Extract

When medical combatants agree to engage in a scientific debate, they usually do so because they enjoy a friendly competition or because they feel passionate about their point of view. Although I did not receive a Jesuit education, the opportunity to spar with the “champ” (Dr Gattinoni has certainly earned that title) was too much of a challenge to pass up. As to the passion about my side of the argument, I will not go overboard but want to emphasize that I do practice what I preach. I will build my case on the foundations of lung mechanics and my interpretation of experiments designed to unravel the biophysical determinants of lung injury. I will integrate these with data from observational studies and from lessons I have learned reviewing the ventilator practice in my institution.1 However, the most compelling reason why I endorse “low” tidal volume (Vt) settings for all patients on mechanical ventilation is because I do not perceive harm associated with this practice. The overall objective of the following arguments is, therefore, to contrast the relative risks of ventilating patients with generous Vts (eg, 10-12 mL/kg predicted body weight [PBW]) with those of a low-Vt strategy (eg, 6-8 mL/kg PBW), even when lung function is near normal.

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