© 2008 American Thoracic Society
Questions on the Reversibility of Lung Collapse in Early Acute ARDSTo the Editor:In their study, Dr. Borges and colleagues (1) showed that it was possible to transform the lung of a patient with acute respiratory distress syndrome (ARDS) into a quite normal lung after an aggressive and thoroughly monitored lung recruitment process. I have the following three remarks for the authors. First, the authors' Table 3, second column from the left, reads that a positive end-expiratory pressure of 5 cm H2O and PPLAT of 30 cm H2O were applied at baseline. By multiplying the pressure difference (i.e., 25 cm H2O) by the median value of compliance of 28.2 ml/cm H2O provided in Table 2, the corresponding tidal volume would amount to 700 ml and, hence, the mean weight of patients would be 115 kg, since they were expected to receive a tidal volume of 6 ml/kg predicted body weight. Is this correct? Second, the authors' Figure 7 showed the computerized tomography scans of a representative patient at key times during the whole process of full recruitment. We are told that Patient 9a (according to Table 2) is the only one who experienced overt barotrauma 12 hours after completing the protocol and died some hours later. Is that correct? Third, the overall mortality is quite high. Since the patients investigated were unselected and there was no control group, no conclusion can be drawn from these results. These data suggest that, even though possible in skilled hands, the extreme approach proposed will not save lives, as illustrated in the remark above.
Hôpital de la Croix Rousse FOOTNOTES Conflict of Interest Statement: The author has no financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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