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In Reply: In response to Dr Oba and Drs Borges and colleagues, we agree that the ability to identify those patients with ALI and ARDS who are most likely to benefit from an open-lung approach is a laudable goal. We hope that our experimental approach to PEEP titration, while taking into consideration lung protection, oxygenation, hemodynamics, and barotrauma, will be improved on in the future with more sophisticated methods of individualizing ventilatory management.

We agree with Borges et al that our approach may have led to an open lung in some patients and overdistention in others. To this extent, the modification in our protocol may have increased the potential for a negative study, as Oba suggests, although our analyses do not detect this effect. Our experimental approach was based on a consensus of individuals, considering current research evidence and routine clinical practices at that time. From our perspective, this choice . . . [Full Text of this Article]

Maureen O. Meade, MD, MSc
meadema@hhsc.ca
McMaster University
Hamilton, Ontario, Canada

Thomas E. Stewart, MD
University of Toronto
Toronto, Ontario