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To the Editor: Acute respiratory distress syndrome (ARDS) is an inflammatory syndrome of the lung with a mortality rate of 35% to 65%.¹ Despite intense research into the mechanisms underlying ARDS, it is unclear why most deaths attributable to ARDS are not from respiratory failure, but rather from progressive dysfunction of other organs, or so-called multisystem organ failure (MSOF).² One hypothesis is that mechanical ventilation, which is invariably used in the care of patients with ARDS, can increase alveolar capillary permeability and augment the pulmonary inflammatory response, leading to increased production of inflammatory mediators (biotrauma).³ If these mediators (eg, cytokines) enter the circulation, they could cause MSOF.⁴

We recently reported a randomized clinical trial in patients with ARDS in which we found that conventional mechanical ventilation induced a pulmonary and systemic inflammatory response that was minimized by a lung protective strategy.⁵ Herein, we present a post-hoc analysis of the relationship . . . [Full Text of this Article]

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