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Comment & Response
March 6, 2018

Lung Recruitment and Positive End-Expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome

Author Affiliations
  • 1Adult Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
  • 2Hospital de Clínicas de Niterói, Universidade Unigranrio, Rio de Janeiro, Brazil
JAMA. 2018;319(9):933. doi:10.1001/jama.2017.21840

To the Editor In a systematic review and meta-analysis of 2299 patients with moderate or severe ARDS, lower mortality was found in the high-PEEP group compared with the low-PEEP group (34.1% vs 39.1%, respectively; P = .049).1 In a second systematic review and meta-analysis of 1594 patients with ARDS, alveolar recruitment maneuvers were associated with reduced in-hospital mortality without increasing the risk of adverse events.2 In addition, a multicenter, randomized clinical trial of 200 patients with moderate to severe ARDS showed that an open-lung approach improved oxygenation and driving pressure, without detrimental effects on mortality, ventilator-free days, or barotrauma.3