1. Tugrul, et al12 studied the effect of SI in 24 adults with ARDS. SI included 45 cm H2O for 30 seconds, followed by a decremental PEEP titration from 20 cm H2O down, titrating to saturations. P/F ratio increased >200 in 11/24 patients, which persisted at 6 hours post-maneuver in 9/24 patients. Barotrauma was not observed in any patients.