Editing Tidal volume (section)

==Mechanical ventilation==
Tidal volume plays a significant role during [[mechanical ventilation]] to ensure adequate ventilation without causing trauma to the lungs. Tidal volume is measured in milliliters and ventilation volumes are estimated based on a patient's ideal body mass. Measurement of tidal volume can be affected (usually overestimated) by leaks in the [[breathing circuit]] or the introduction of additional gas, for example during the introduction of [[Nebulizer|nebulized]] drugs.

Ventilator-induced lung injury such as [[Acute lung injury]] (ALI) /[[Acute Respiratory Distress Syndrome]] (ARDS) can be caused by ventilation with very large tidal volumes in normal lungs, as well as ventilation with moderate or small volumes in previously injured lungs, and research shows that the incidence of ALI increases with higher tidal volume settings in nonneurologically impaired patients. 
.<ref>{{cite journal|last=Gajic|first=Ognjen|author2=Saqib Dara |author3=Jose Mendez |author4=Abedola Adensanya |author5=Emir Festic |author6=Sean Caples |author7=Rimki Rana |author8=Jennifer StSauver |author9=James Lymp |author10=Bekele Afessa |title=Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation|journal=Critical Care Medicine|year=2004|volume=32|issue=9|pages=1817–1824|doi=10.1097/01.CCM.0000133019.52531.30|pmid=15343007|s2cid=6386675}}</ref>  Similarly A 2018 systematic review by [[The Cochrane Collaboration]] provided evidence that low tidal volume ventilation reduced post operative pneumonia and reduced the requirement for both invasive and non invasive ventilation after surgery<ref>{{Cite journal|last1=Guay|first1=Joanne|last2=Ochroch|first2=Edward A|last3=Kopp|first3=Sandra|date=2018-07-09|title=Intraoperative use of low volume ventilation to decrease postoperative mortality, mechanical ventilation, lengths of stay and lung injury in adults without acute lung injury|journal=Cochrane Database of Systematic Reviews|volume=7|issue=10 |pages=CD011151|doi=10.1002/14651858.cd011151.pub3|issn=1465-1858|pmc=6513630|pmid=29985541}}</ref>

Initial settings of mechanical ventilation:

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===Patients without pre-existing lung disease===
Protective lung ventilation strategies should be applied with V<sub>T</sub> 6ml/kg to 8ml/kg with RR = 12 to 20 and an average starting target minute ventilation of 7 L/min.{{citation needed|date=January 2022}}{{clarify|Why?|date=January 2022}}

===Patients with chronic obstructive lung disease===
Protective lung volumes apply 6ml/kg to 8ml/kg with a rate high enough for proper alveolar ventilation but does not create or aggravate intrinsic Positive End-Expiry Pressure (PEEP).{{citation needed|date=January 2022}}{{clarify|what is proper alveolar ventilation and how is it identified?|date=January 2022}}

===Acute respiratory distress syndrome===
Protective lung ventilation strategies apply. V<sub>T</sub> 6 to 8&nbsp;ml/kg or as low as 5&nbsp;ml/kg in severe cases. Permissive hypercapnia can be employed in an attempt to minimize aggressive ventilation leading to lung injury. Higher PEEPs are often required however not all ARDS patients require the same PEEP levels.{{clarify|Why not?|date=January 2022}} Patient should be started on 6&nbsp;ml/kg and PEEP increased until plateau pressure is 30&nbsp;cm&nbsp;H<sub>2</sub>0 in most severe cases.{{citation needed|date=January 2022}}{{clarify|Why?|date=January 2022}}