The evidence supporting low tidal volume ventilation does not apply to patients who undergo very short periods of MV, nor does it alter their outcomes.
The patient is on minimal settings for the entirety of MV, defined as a spontaneous mode (e.g., pressure support ventilation) with pressure support < 10 cmH2O, and PEEP < 8 cmH20, and FiO2 < 50%.
The clinical significance of spontaneous tidal volumes is unknown and low tidal volumes may not be beneficial or desirable.
Goals of care are documented as comfort measures only during the first 72 h during episode of MV.
MV is managed differently during care focused exclusively on comfort and low tidal volume ventilation may not be appropriate, nor would it be expected to influence clinical outcomes.
There is no height documented in the EHR at the time of initiation of MV.
We will be unable to estimate ideal body weight, a necessary parameter to calculate the primary outcome, and patient’s without a documented height will not receive the interventions.
