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In Reply: Drs Haitsma and Pelosi state that oxygenation may be improved by a recruitment maneuver that leads to a short-term increase in plateau pressure. Oxygenation, which we do not consider a solid end point in patients with ALI/ARDS,¹ was already markedly improved in the high PEEP group of the Express trial. Recruitment maneuvers can have severe adverse effects, and in the absence of evidence that fully recruiting the lung is clinically important, we preferred not to recommend such maneuvers in our trial.

Dr Oba suggests that a PEEP titration based on the static compliance of the respiratory system could result in a better outcome than the method we used. Our experience is that compliance is difficult to use at the bedside for PEEP titration. The changes in compliance induced by increased PEEP are often quite small, and recruitment can be associated with a decrease in linear compliance measured at . . . [Full Text of this Article]

Alain Mercat, MD
almercat@chu-angers.fr
Département de Réanimation Médicale et Médecine Hyperbare
CHU d’Angers
Angers, France

Jean-Christophe Richard, MD
Service de Réanimation Médicale
CHU de Rouen
Rouen, France

Laurent Brochard, MD
Service de Réanimation Médicale
AP-HP, Centre Hospitalier Albert Chenevier–Henri Mondor
Créteil, France

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