![]() The striking finding by Lellouche et al. , 1however, is that such common practice (tidal volumes of more than 10 ml/kg of PBW) was associated with prolonged mechanical ventilation, hemodynamic instability, higher incidence of renal failure, and prolonged stay in the intensive care unit among patients who underwent cardiac surgery, compared with low tidal volumes. Such findings are not really surprising and mirror clinical practice worldwide, where protective ventilation has been regarded as superfluous, because uninjured lungs shall be robust enough to overcome tidal volumes of that magnitude. Organ dysfunction was defined as mechanical ventilation exceeding 24 h (prolonged mechanical ventilation), use of vasopressors or inotropes for more than 48 h after surgery (hemodynamic instability), or increase in creatinine levels more than 50 μM after surgery compared with baseline values (renal failure), according to the Society of Thoracic Surgeons.‡Authors found that low tidal volumes, i.e. , less than 10 ml/kg of PBW, have been used in only about 21% of 3,434 patients included in the study, whereas the vast majority received tidal volumes more than 10 ml/kg, or even more than 12 ml/kg of PBW. 1report on the results of a prospective observational trial that investigated the effects of low, traditional, and high tidal volumes (less than 10, 10–12, and more than 12 ml/kg of predicted body weight, respectively) delivered after admission into the intensive care unit on the development of organ dysfunction after cardiac surgery. IN this issue of ANESTHESIOLOGY, Lellouche et al.
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