Closing, opening and reopening: the difficult coexistence

Volume-controlled ventilation (VCV) has always been considered as protective ventilation, in particular during spontaneous breathing, being able to avoid the administration of injurious tidal volumes (V_t) to the patient. In fact, spontaneous efforts increase transpulmonary pressure (P_l) only during pressure-regulated ventilations (1). Despite this difference in terms of P_l, the conditions of lung parenchyma determine the damage to the lung tissue and the onset of ventilator induced lung injury (VILI).