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How Low Can You Go: Mechanical Ventilation Over Time

Wanderer, Jonathan P. MD, MPhil; Nathan, Naveen MD

doi: 10.1213/ANE.0000000000004245
Infographics: Infographic

Vanderbilt University School of Medicine (

Northwestern University Feinberg School of Medicine (

Published ahead of print 23 April 2019.

The Infographic is composed by Jonathan P. Wanderer, MD, MPhil, Vanderbilt University School of Medicine (, and Naveen Nathan, MD, Northwestern University Feinberg School of Medicine ( Illustration by Naveen Nathan, MD.

The authors declare no conflicts of interest.

Clinical practices around mechanical ventilation have changed significantly over time in both the operating room and intensive care unit setting, shifting from a methodology focused on relatively large tidal volume ventilation to one characterized by smaller tidal volume ventilation and usage of positive end-expiratory pressure. These changes have been due to the accumulation of evidence over time that better pulmonary outcomes are achieved with more modern ventilation practices. In this infographic, we review the timeline across which these changes occurred, the major pieces of evidence supporting the change, and a recent systematic review that has measured these changes over time across hundreds of cohorts of patients.

ICU indicates intensive care unit; OR, operating room; PEEP, positive end-expiratory pressure; RCTs, randomized controlled trials; Vt, tidal volume

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