In Reply Dr McKown and colleagues suggest that the method used to personalize PEEP might be one explanation for the higher mortality in the recruitment maneuver and PEEP titration group. When multiple PEEP levels had similar compliance, we set the PEEP at 2 cm above the highest of these levels based on observations from a previous case series.1 Mean PEEP levels used in the experimental group were similar to other high-PEEP trials. We also used a tidal volume of 5 mL/kg predicted body weight during PEEP titration, although tidal volume was set at 6 mL/kg during maintenance ventilation (or lower if plateau pressure >30 cm H2O). We acknowledge that using the same tidal volume both during PEEP titration and maintenance ventilation would have been a better choice, although the small differences between tidal volume during PEEP titration and maintenance ventilation were unlikely to substantially change the level of optimal PEEP.
Cavalcanti AB, Amato MBP, Ribeiro de Carvalho CR. Lung Recruitment and Positive End-Expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome—Reply. JAMA. 2018;319(9):934–935. doi:10.1001/jama.2017.21864
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