In their retrospective observational analysis of patients undergoing one-lung ventilation during thoracic surgery, Colquhoun et al. did not detect an independent association between a low tidal lung protection ventilation regimen and a composite of postoperative pulmonary complications. However, there are two additional factors that may have an impact on this finding.

First, the right lung is larger than the left lung. Normally, the left lung receives a smaller tidal volume than the right lung. By using the same tidal volume for both the left and right lungs, it is possible that a tidal volume that is protective for the right lung may be excessive for the left lung. Without accounting for this difference, it is possible that the left lung did not accrue the full benefit of low tidal volume ventilation and might have had greater injury....

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