In Reply Drs Li and Shi raised concerns about which of our study groups actually provided intensive alveolar recruitment. In Supplement 2, eFigure 4 and eTable 1 showed that the intensive maneuver resulted in better reversal of atelectasis (our main target). At arrival in the intensive care unit, electrical impedance tomography maps showed reduced ventilation and compliance of dependent lung regions for all patients (upper:lower ventilation ratio above 1:1), but a larger improvement occurred after the intensive maneuvers (upper:lower ventilation ratio decreased to 0.6 vs 1.2 in the moderate strategy group), leading to higher respiratory-system compliance (65 vs 50 mL/cm H2O) and better oxygenation (arterial partial pressure of oxygen [Pao2]/Fio2 ratio = 344 vs 236). The comparison between study groups was significant for all parameters.
Amato MBP, Volpe MS, Hajjar LA. Alveolar Recruitment Strategies After Cardiac Surgery—Reply. JAMA. 2017;318(7):668–669. doi:10.1001/jama.2017.8697