1. Borges, Amato, et al6 have performed the most convincing and complete study of the maximal recruitment maneuver to date. In it, they studied 26 adults early in the course of ARDS comparing the open lung approach (including SI of 40 cm H2O for 40 seconds, followed by PEEP set at Pflex + 2 cm H2O, described below) with the maximal recruitment strategy, performed in sequence. Maximal recruitment was defined as a PaO2 plus PaCO2 exceeding 400 mm Hg, indicative of minimal intrapulmonary shunting. The strategy included pressure controlled ventilation of 15 cm H2O, with PEEP increased in 5 cm H2O increments every 5 minutes (maximum PEEP 45 cm H2O) until maximal recruitment was achieved. Maximal recruitment was achieved in 24/26 patients, two thirds of which were achieved by a PEEP of 30 cm H2O. Utilizing a PEEP titration to maintain lung recruitment (see below), PaO2 remained above 400 (lungs fully recruited) in all patients at 6 hours. The procedure was tolerated hemodynamically in all patients and the long-term incidence of barotrauma in study patients (7.7%) was lower than the recognized incidence in ARDSNet studies (10-11%)8.