Key messages

• Most critically ill patients should be ventilated with a tidal volume of 5 to 15 ml/kg.

• Acceptable Paco2: the risk of ventilator-induced lung injury due to a large tidal volume may alter the acceptable Paco2 range.

• Metabolic rate: alterations in alveolar minute ventilation to adjust for metabolic rate changes can often be accomplished by tidal volume changes.

• Physiological dead-space: this changes on commencement of positive-pressure ventilation, and its relationship with tidal volume is not constant.

• Respiratory rate: this also governs alveolar minute ventilation.

• Risk of ventilator-induced lung injury: both plateau pressure and auto-PEEP should be minimized.

• Oxygenation: atelectasis due to inadequate tidal volume should be avoided.

• Circuit compressible volume: this will reduce the delivered tidal volume.

• Cardiovascular stability: increases in intrathoracic pressure with increasing tidal volume may lead to hemodynamic instability.

• Mode of ventilation: tidal volume cannot be set directly in pressure-targeted or spontaneous ventilation.

• Patient comfort: some patients feel more comfortable with a tidal volume at the upper end of the aforementioned range.

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