It is important to note three aspects of this study which are likely responsible for the excessively high percentage of non-recruitable lung, in contrast with the highly successful recruitment strategy outlined by Borges, et al. First, Borges studied patients early in the ARDS course (median, 2 days) while Gattinoni studied late ARDS. Second, Borges utilized peak pressures as high as 60 cm H2O, while Gattinoni utilized pressures up to 45 cm H2O. Finally, Gattinoni did not practice a PEEP titration, but lowered PEEP to 5 cm H2O following recruitment maneuvers. Thus, Gattinoni's study highlights the importance of high peak pressures in lung recruitment, of recruiting early in ARDS, and of a decremental PEEP titration to maintain lung recruitment.