To the Editor The trial by the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators1 compared a low positive end-expiratory pressure (PEEP) strategy2 with one combining a recruitment maneuver and PEEP titration personalized to respiratory system compliance among adults with moderate to severe acute respiratory distress syndrome (ARDS). The recruitment maneuver and personalized PEEP approach lowered driving pressure but increased mortality. Although one potential explanation for increased mortality is the negative effects of the recruitment maneuver, another is ventilator-induced lung injury from overdistension of alveoli at end-inspiration (tidal hyperinflation) resulting from the method of personalizing PEEP.
McKown AC, Semler MW, Rice TW. Lung Recruitment and Positive End-Expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome. JAMA. 2018;319(9):932–933. doi:10.1001/jama.2017.21856
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