2. Amato, et al16 studied the effects of a 'protective ventilation strategy' in 53 patients with ARDS. The protective ventilation group received recruitment maneuvers via sustained inflation (35-40 cm H2O for 40 seconds) followed by PEEP set at LIP + 2 cm H2O. The control group received a PEEP titrated to saturations, no recruiting maneuvers. The protective ventilation group had a dramatic decrease in 28 day all-cause mortality (38% vs 71%, p<0.001). However, the control group also received high tidal volume ventilation (12 mL/kg), later proven to be a significant determinant in ARDS mortality.8 Therefore, the contribution of RM and open lung approach to the improved mortality of this study, if any, is difficult to conclude.