What tidal volumes should be used in patients without acute lung injury?

Mechanical ventilation practice has changed over the past few decades, with tidal volumes (V-T) decreasing significantly, especially in patients with acute lung injury (ALI). Patients without acute lung injury are still ventilated with large-and perhaps too large-V-T Studies of ventilator-associated lung injury in subjects without ALI demonstrate inconsistent results. Retrospective clinical studies, however, suggest that the use of large V-T favors the development of lung injury in these patients. Side effects associated with the use of lower V-T in patients with ALI seem to be minimal. Assuming that this will be the case in patients without ALI/acute respiratory distress syndrome too, the authors suggest that the use of lower V-T should be considered in all mechanically ventilated patients whether they have ALI or not. Prospective studies should be performed to evaluate optimal ventilator management strategies for patients without ALI.