Lung Recruitment in Patients with ARDS

To the Editor: In the April 27 issue, Gattinoni et al.¹ suggest that the potential for lung recruitment in patients with acute lung injury is generally low and extremely variable among patients. We believe that a suboptimal recruitment maneuver explains such results, contradicting investigations²⁴ that demonstrate a much larger potential for recruitment and greater homogeneity of response. Gattinoni et al. used an inspiratory plateau pressure of 45 cm of water, a pressure certainly below the critical opening pressures reported in recent studies²⁴ in humans. The investigators also allowed expiratory pressures to repeatedly fall to 5 cm of water, . . .