However, we suggest that the claim by Fuehner et al to limit peak inspiratory pressures (Pinsp) to 35 cm H2O following lung transplantation is too liberal. The Acute Respiratory Distress Syndrome Clinical Network (ARDSNet) investigators actually suggested limiting plateau pressures to 30 cm H2O in their protective ventilation strategy. Our recent analysis of ventilation strategies after lung transplantation suggested a survival advantage for patients who received Pinsp < 25 cm H2O within the first few hours following surgery. Our small retrospective study reopens the debate on volume vs pressure paradigms of injurious ventilation and sets a lower pressure target for protective ventilation within this unique patient population. Recent revelations on the interplay between driving pressures, lung injury, and outcomes in both the ARDS and general perioperative populations would also advocate the aggressive limitation of inspiratory pressures, especially in the setting of lower levels of positive end-expiratory pressure (PEEP).