{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:41:05Z","timestamp":1793320865327,"version":"4.5.0"},"reference-count":70,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Lung-protective ventilation strategies are the current standard of care for patients with acute respiratory distress syndrome in an effort to provide adequate ventilatory requirements while minimizing ventilator-induced lung injury. Some patients may benefit from ultra\u2013lung-protective ventilation, a strategy that achieves lower airway pressures and Vt than the current standard. Specific physiological parameters beyond severity of hypoxemia, such as driving pressure and respiratory system elastance, may be predictive of those most likely to benefit. Because application of ultra\u2013lung-protective ventilation is often limited by respiratory acidosis, extracorporeal membrane oxygenation or extracorporeal carbon dioxide removal, which remove carbon dioxide from blood, is an attractive option. These strategies are associated with hematological complications, especially when applied at low blood-flow rates with devices designed for higher blood flows, and a recent large randomized controlled trial failed to show a benefit from an extracorporeal carbon dioxide removal\u2013facilitated ultra\u2013lung-protective ventilation strategy. Only in patients with very severe forms of acute respiratory distress syndrome has the use of an ultra\u2013lung-protective ventilation strategy\u2014accomplished with extracorporeal membrane oxygenation\u2014been suggested to have a favorable risk-to-benefit profile. In this critical care perspective, we address key areas of controversy related to ultra\u2013lung-protective ventilation, including the trade-offs between minimizing ventilator-induced lung injury and the risks from strategies to achieve this added protection. In addition, we suggest which patients might benefit most from an ultra\u2013lung-protective strategy and propose areas of future research.<\/jats:p>","DOI":"10.1164\/rccm.202110-2252cp","type":"journal-article","created":{"date-parts":[[2022,1,19]],"date-time":"2022-01-19T16:32:45Z","timestamp":1642609965000},"page":"873-882","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":43,"title":["Risks and Benefits of Ultra\u2013Lung-Protective Invasive Mechanical Ventilation Strategies with a Focus on Extracorporeal Support"],"prefix":"10.1093","volume":"205","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9073-3897","authenticated-orcid":false,"given":"Darryl","family":"Abrams","sequence":"first","affiliation":[{"name":"Columbia University College of Physicians and Surgeons\/New York-Presbyterian Hospital, New York, New York"},{"name":"Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New 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ECMO Center, Cologne-Merheim Hospital, Witten\/Herdecke University Hospital, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Purnema","family":"Madahar","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons\/New York-Presbyterian Hospital, New York, New York"},{"name":"Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie H.","family":"Yip","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons\/New York-Presbyterian Hospital, New York, New York"},{"name":"Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Pesenti","sequence":"additional","affiliation":[{"name":"Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, 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