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Highly Accessed Open Badges Commentary

Ultra-protective tidal volume: how low should we go?

Eduardo LV Costa12* and Marcelo BP Amato1

Author Affiliations

1 Cardio-Pulmonary Department, Pulmonary Division, Hospital das Clínicas, University of São Paulo, Av. Dr. Arnaldo 455, sala 2144 (2nd floor), São Paulo, SP, Brazil. CEP: 01246-903

2 Research and Education Institute of Hospital Sírio Libanês in São Paulo, R Cel Nicolau dos Santos, 69, São Paulo, Brazil. CEP: 01308-60

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Critical Care 2013, 17:127  doi:10.1186/cc12556

See related research by Retamal et al.,

Published: 28 March 2013


Applying tidal volumes of less than 6 mL/kg might improve lung protection in patients with acute respiratory distress syndrome. In a recent article, Retamal and colleagues showed that such a reduction is feasible with conventional mechanical ventilation and leads to less tidal recruitment and overdistension without causing carbon dioxide retention or auto-positive end-expiratory pressure. However, whether the compensatory increase in the respiratory rate blunts the lung protection remains unestablished.