Alveolar Collapse Is a Threat in Injured Lungs, but What About the Airway Opening Pressure?

We read with interest the study by Sousa and colleagues that was published recently in the Journal (1). In a two-hit porcine homogenous lung injury model (surfactant depletion and high stretch ventilation), ventilation with positive end-expiratory pressure (PEEP) set to minimize overdistension (<3% of overdistension) resulted in a high amount of lung collapse and a higher risk of mortality attributed to right heart failure followed by cardiopulmonary collapse.