The mechanism of barotrauma and volutrauma has been described since the 70s in patients with acute lung injury and acute respiratory distress syndrome receiving high tidal volume ventilation1 (10–15 ml/kg ideal body weight). This led to the development of controlled clinical trials in an attempt to determine the ideal tidal volume. Different forms of mechanical ventilation were proposed in the 90s using tidal volumes ranging between 3-12 ml/kg of the estimated weight.2 However, it was only in 2000 when the ARMA study published by the ARDS Network provided recommendations for low-volume mechanical ventilation (6 ml/kg) and airway plateau pressures under 30 cm H2O, leading to a significant