Since the publication of the original landmark trial detailing the mortality benefits of low tidal volume ventilation among patients with the acute respiratory distress syndrome (non-cardiogenic pulmonary edema) (Amato et al. in The New England Journal of Medicine 342(18):1301–1308), epidemiological studies have demonstrated that tidal volumes used for mechanically ventilated patients in medical intensive care units have become lower over time (Esteban et al. in American Journal of Respiratory and Critical Care Medicine 177(2):170–177; Esteban et al. in American Journal of Respiratory and Critical Care Medicine 188(2):220). Because patients with heart failure (cardiogenic pulmonary edema) have been systematically excluded from studies investigating low tidal volume mechanical ventilation, the benefit of a low tidal volume strategy among cardiac patients is unclear. We sought to determine whether evidence supporting use of low tidal volumes in patients with non-cardiogenic edema has been generalized into the care of patients with cardiogenic pulmonary edema.