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To the Editor: The studies by Dr Meade and colleagues¹ and Dr Mercat and colleagues² were intended to test a strategy aimed at maximizing alveolar recruitment while limiting hyperinflation. To guarantee applicability at the bedside, both studies made use of fixed targets such as plateau pressures or PEEP/FIO ₂ ratios with PEEP levels adjusted accordingly. Because PEEP levels were not primarily titrated, the question is how much this approach compromised the test of an "optimum-PEEP" in favor of a "feasible-PEEP."

In the Lung Open Ventilation Study,¹ patients demonstrating easy lung recruitment, possibly those in whom the FIO ₂ could be immediately reduced to 40% (after recruiting maneuvers and an initial PEEP of 20 cm H₂O), may have been immediately submitted to a PEEP of only 10 cm H₂O. In contrast, patients not easily achieving recruitment, requiring FIO ₂ levels at or above 50% after the recruitment maneuver, were . . . [Full Text of this Article]

João Batista Borges, MD
jbborges@unisys.com.br

Carlos Roberto Ribeiro Carvalho, MD; Marcelo Britto Passos Amato, MD
University of São Paulo
São Paulo, Brazil

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