Intraoperative Low-Tidal-Volume Ventilation

To the Editor: We are troubled by the ventilation strategy selected for the control group (or nonprotective-ventilation group) in the study by Futier et al. (Aug. 1 issue). 1 This strategy (nonprotective ventilation with a tidal volume of 10 to 12 ml per kilogram of predicted body weight, with no positive end-expiratory pressure [PEEP] and no recruitment maneuvers) is known to be potentially harmful and is outdated (the authors cite a study from 1963 2 to define their standard of care).The tidal volumes recommended in contemporary strategies 3,4 for perioperative ventilation are less than 10 ml per kilogram of predicted body weight, and they are provided with PEEP.To analyze practice patterns for patients undergoing anesthesia, we undertook a study in which we reviewed data from 230,386 surgical procedures at two institutions.These data show that PEEP with a median of 5 cm of water was used in 60.4% of procedures.Median tidal volumes declined from 9.2 to 7.9 ml per kilogram of predicted body weight between 2005 and 2013.Prospective studies such as that by Futier et al. are most relevant if they derive their data from recent observational studies that used contemporary standards of care.Moreover, these data can be derived from clinical-decision support databases.