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Pressure vs. volume ventilation: ICU

No trial has convincingly demonstrated the superiority of any given ventilatory mode over any other. ARDS Network data (NEJM 2000) provides high level evidence for limiting tidal volumes to no more than 6ml/kg in patients with ALI/ARDS. Whether this is accomplished with pressure or volume regulated ventilation is at the discretion of the treating physician, given the available evidence (January 2012). Pressure control ventilation is advantageous in avoiding barotrauma in stiff/noncompliant lungs but may result in hypoventilation (usually non-injurious). Volume control ventilation risks barotrauma by delivering a set tidal volume. Of course, modern ICU and OR ventilators give us the best of both worlds with pressure-limited volume control or volume-targeted pressure control modes.