Safe mechanical ventilation in patients without acute respiratory distress syndrome (ARDS)

Insights into the pathogenesis of lung deformation injury inspired a benchmark clinical trial, which demonstrated that reducing tidal volumes compared to previous norms was associated with improved patient survival in acute respiratory distress syndrome (ARDS). Since many critically ill patients without ARDS possess ventilator associated lung injury (VALI) risk factors, there is no need to expose them to tidal volumes that are larger than would be needed to achieve acceptable blood gas tensions. In the following perspective we will argue that lung protection from deformation injury should guide ventilator management in all patients, irrespective of the presence of ARDS. That is not to say that all lung diseases share the same VALI risk, but we contend that adopting a low tidal ventilation strategy is a simple and safe starting point in most instances. We will review studies in the medical and surgical literature that have addressed "lung protective ventilation" in patients without ARDS and summarize them with a focus on tidal volume, positive end expiratory pressure and oxygen supplementation settings. In addition, we will briefly discuss under what circumstance one might consider deviating from a conventional approach.