Is Mechanical Ventilation Protective Just Because We Say So?

In a recent issue of the American Journal of Critical Care, Chian and colleagues presented a case report describing the management of a patient who devel-oped acute respiratory distress syndrome (ARDS) fol-lowing inhalation of gas from a smoke bomb.1 Much of the report focused on the use of extra-corporeal life support to overcome recalcitrant hypox-emia. I would like to comment briefly on the mechanical ventilation strategies that were employed. The authors described numerous ventilator modes used in the effort to find optimal oxygenation response and patient-ventilator synchrony. Initial ven-tilator settings were a volume-controlled mode with a tidal volume of 500 mL. On day 16, the ventilator was changed to pressure-controlled ventilation tha