In Response

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We thank Dr Zochios for his interest in our article.1 We found that tidal volume by itself was not associated with a greater incidence of pneumonia and/or acute respiratory distress syndrome in conjunction with other goals to avoid lung injury such as minimizing peak airway pressure and intraoperative fluid intake. We agree with Dr Zochios that driving pressure is an important component of achieving nonharmful ventilation of patients in the operating room. In our discussion, we have referenced the study by Ladha et al2 reporting that driving pressure and not tidal volume was associated with pulmonary complications after noncardiothoracic surgery using a large database.
Dr Zochios referred to an abstract by McCall et al of 27 patients whose right ventricular ejection function was estimated by cardiac magnetic resonance imaging and showed a small statistical decrease in right ventricular ejection fraction on postoperative day 2 and 2 months after surgery. In our extensive experience using real time 2D echocardiography before, immediately after, and 30–60 days after surgery, we have not appreciated significant changes in right heart function that were clinically meaningful.3–5 We have rarely observed only right ventricular failure in patients who developed acute respiratory distress syndrome and cor pulmonale after a pneumonectomy.
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