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To the Editor: I believe that the design of the Lung Open Ventilator Study by Dr Meade and colleagues¹ made an error by adjusting PEEP according to FIO ₂, leading to overdistention of alveoli as evidenced by lower static compliance (tidal volume / [plateau pressure – end-expiratory pressure]) in the high PEEP group than in the lower PEEP group.² The mean levels of compliance in the high and low PEEP groups were 0.41 and 0.42 mL/kg/cm H₂O on day 3 and 0.37 and 0.41 mL/kg/cm H₂O on day 7, respectively. Despite a similar protocol, the same phenomenon was not observed in the ALVEOLI study,³ possibly due to the difference in patient population. The protocol change in the middle of the study allowing higher PEEP levels in the Lung Open Ventilator Study might have negatively affected the study results.

The results of the Express study by Dr Mercat and colleagues⁴ could also . . . [Full Text of this Article]

Yuji Oba, MD
obay@health.missouri.edu
Pulmonary, Critical Care, and Environmental Medicine
University of Missouri–Columbia

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