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How does the ART trial [JAMA.2017;318(14):1327-1329] change your practice regarding PEEP titration and recruitment maneuvers in patients with moderate to severe ARDS? In both study groups the average tidal volumes were <6cc/kg PBW, plateau pressures <30 cmH2O, and driving pressures <15 cmH2O, and yet all-cause 6-month mortality was 6% higher in the experimental than in the control group (65.3% vs 59.9%). Are recruitment maneuvers as harmful as this well-powered RCT would have us believe?

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