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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Dr Mercat and colleagues¹ reported the results of the Express trial comparing a minimal alveolar distention strategy with a strategy aiming for maximal alveolar recruitment while limiting hyperinflation. Although there was no difference in the primary end point (28-day mortality rate), the maximal alveolar recruitment strategy resulted in more ventilator-free days, more organ failure–free days, and less frequent use of rescue therapy. However, there are certain points that merit attention.

First, the screening for PEEP weaning was determined by the PaO ₂:FIO ₂ ratio. This ratio depends on the PEEP level, which was by design not equal between groups. Higher PEEP level will result in higher PaO ₂:FIO ₂ ratio, favoring early weaning in the increased recruitment group and possibly contributing to the reduced time spent on mechanical ventilation in this group.

Second, the amount of alveolar recruitment and alveolar hyperinflation by PEEP is a . . . [Full Text of this Article]

L. M. A. Heunks, MD, PhD
l.heunks@ic.umcn.nl

J. G. van der Hoeven, MD, PhD
Radboud University Nijmegen Medical Centre
Nijmegen, the Netherlands

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