Ventilation and Complications after Lung Resection: Comment

We read with great interest the review paper by Walsh et al. published recently in Anesthesiology, which concluded that utilizing low tidal volume settings in non–acute respiratory distress syndrome (ARDS) intensive care unit (ICU) or thoracic surgery patients did not change clinical outcomes.¹  Although the Acute Respiratory Distress Syndrome Network (ARDSNET) trial published in 2000 cemented the use of low tidal volume (6 ml/kg predicted body weight) in ICU ARDS patients, the ensuing two decades saw a multitude of trials in non-ARDS ICU patients and surgical patients with contradictory findings.²  While many were observational or retrospective trials with their inherent biases, even more recent randomized clinical trials seemed to suffer from the same contradictory results.^3–8  Are we therefore to conclude that tidal volume size does not matter in non-ARDS patients? Is it possible that this murky answer stems from asking the wrong questions? Rather than continuing...