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Editorials: POINT/COUNTERPOINT EDITORIALS |

Rebuttal From Dr GattinoniRebuttal From Dr Gattinoni

Luciano Gattinoni, MD
Author and Funding Information

From the Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, and Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Università degli Studi.

Correspondence to: Luciano Gattinoni, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza, 35, 20122 Milano, Italy; e-mail: gattinon@policlinico.mi.it


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):15. doi:10.1378/chest.11-0828
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Extract

The pro-con format is an ancient academic game. As far as I recall, Galileo was involved at the Padua University in a pro-con debate about the relative motion of the sun and the earth. At the end of a hot debate, several wounded supporters were counted within pro and con factions. Nowadays, a smoother approach is taken, and I would prefer that the mainstream of pro-con debates be the search for the truth under different lights. Knowing his intellectual honesty, I believe that Dr Hubmayr has the same attitude. In fact, at the end of his point editorial, he says, “I suspect that in a normal lung, in the absence of other stressors, the clinical manifestations of high-Vt [tidal volume] ventilation are generally subtle and inconsequential.”1 On the other hand, my conclusion of the counterpoint editorial was that “if in a given ICU there is not the possibility of such measurements [stress and strain], a lower Vt/IBW [ideal body weight] would anyway be a better choice than a higher one.”2 It is quite evident that, although we use different words, we are expressing the same concept; that is, in a busy unit without the possibility of more sophisticated monitoring, a Vt of 7 mL/kg IBW, as suggested by Dr Hubmayr, is a reasonably safe choice. Incidentally, during the 2011 International Symposium on Intensive Care and Emergency Medicine in Brussels, Belgium, in a discussion of a worldwide survey on mechanical ventilation, Dr Esteban3 showed that the average Vt used around the world is ≈ 7.2 mL/kg IBW, indicating that Dr Hubmayr is at least in wide, if not good, company.

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