Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliations: Medical Intensive Care Unit, ABC Medical School, Santo André, São Paulo, Brazil (Dr Serpa Neto; email@example.com); and Department of Intensive Cre Medicine, University of Amsterdam, Amsterdam, the Netherlands (Dr Schultz).
In Reply: We agree with Mr Zhang that small study bias is a limitation of our study. We tried to correct the results through analysis of publication bias assessed by funnel plots; stratified analysis according to methodological quality of the studies; and assessment of clinical heterogeneity through subgroup analyses and statistical heterogeneity through I2 analysis. However, after extensive search, the studies included in the meta-analysis were all that were available on the topic.
Serpa Neto A, Schultz MJ. Protective Ventilation for Patients Without Acute Respiratory Distress Syndrome—Reply. JAMA. 2013;309(7):654. doi:10.1001/jama.2012.197021