In Reply: Drs Haitsma and Pelosi state that oxygenation may be improved by a recruitment maneuver that leads to a short-term increase in plateau pressure. Oxygenation, which we do not consider a solid end point in patients with ALI/ARDS,1 was already markedly improved in the high PEEP group of the Express trial. Recruitment maneuvers can have severe adverse effects, and in the absence of evidence that fully recruiting the lung is clinically important, we preferred not to recommend such maneuvers in our trial.
Mercat A, Richard J, Brochard L. Ventilation Strategies for Acute Lung Injury and Acute Respiratory Distress Syndrome—Reply. JAMA. 2008;300(1):39-43. doi:10.1001/jama.300.1.41-b