Schemes for Prioritizing Competing Clinical Objectives

Surveys of physicians' use of mechanical ventilation in ARDS demonstrated great variability in practices [28-30]. Some physicians used generous Vt with higher airway pressures. This approach gave high priority to traditional goals of maintaining gas exchange and breathing comfort; it gave lower priority to preventing VILI from overdistention. Other physicians used moderate or small Vt with lower airway pressures. This approach gave higher priority to preventing VILI from overdistention; it gave lower priority to maintaining gas exchange and breathing comfort. There was also great variability in physicians' use of PEEP [28]. These differences in physicians' practices reflect disparity in physicians' estimations of the risks and benefits of the different approaches to setting Vt and levels of PEEP. Randomized clinical trials were necessary to provide clinically relevant information to guide clinician practice.

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