Lung protective ventilatory strategy (LPVS) implying the use oflower tidal volume and limiting the peak inspiratory pressure duringventilation in patients with ALI and ARDS may reduce injuriouslung stretch and release of inflammatory mediator, however the downside of pressure limitation is that the minute ventilation isdecreased with subsequent hypercapnia. In addition, the lowvolumes generated leads to increased tendency to collapse whichmust be countered by a concurrent lung recruitment strategy.