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To the Editor: The study of PEEP settings in adults with ALI and ARDS by Dr Mercat and colleagues¹ did not find a mortality benefit in patients in the increased recruitment (high-PEEP) group compared with patients in the minimal distension arm. Lungs of patients with ARDS are likely to be less compliant, with resulting higher plateau pressures during volume-controlled ventilation.^2-3 In the increased recruitment group, patients with ARDS, compared with patients with less ALI and more compliant lungs, would receive lower levels of PEEP at the target plateau pressure of 30 cm H₂O. This PEEP level may have been close to that applied in the minimal distension group in which the PEEP level was restricted between 5 and 9 cm H₂O. It is therefore possible that in patients with severe forms of lung injury, there may not have been meaningful differences between the actual PEEP levels achieved in . . . [Full Text of this Article]

Jigeeshu Divatia, MD
jdivatia@vsnl.com

Priya Ranganathan, MD
Department of Anaesthesiology, Critical Care and Pain
Tata Memorial Hospital
Mumbai, India

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