“Clinicians set a target minute ventilation, and the ventilator determines an optimal VT and rate combination that result in the least work of breathing, based on the “minimum work of breathing” concept described by Otis et al.53 Theoretically, when the patient’s compliance is reduced (ie, has ALI), a smaller VT and faster rate are chosen, whereas in patients with obstructive lung disease, a larger VT and slower rate are chosen to minimize air trapping. There is concern that large VTs and high pressure may also increase the risk of developing ALI or ARDS in patients without lung disease.”