Ventilator-Induced Lung Injury

To the Editor: Slutsky and Ranieri (Nov. 28 issue)(1) note that ventilator-induced lung injury may be minimized by means of lung-protective mechanical ventilation or by avoiding it altogether with the use of extracorporeal life-support techniques(2) such as by extracorporeal removal of carbon dioxide or extracorporeal membrane oxygenation (ECMO). However, there is no consensus regarding ventilator settings during extracorporeal respiratory support. For example, with removal of extracorporeal carbon dioxide, there is usually some degree of mechanical ventilation, whereas patients undergoing ECMO can receive support without mechanical ventilation. While we await the results of controlled trials regarding this question,(3),(4) are the ...