In Reply:—

We appreciate the interest expressed by Drs. Pestel and Rothhammer with regard to our recent article. 1Although pressure-controlled ventilation with positive end-expiratory pressure is an integral component of our treatment algorithm, we did not measure pressure–volume curves of the lungs, but rather set the values of positive end-expiratory pressure and peak inspiratory pressure according to previous clinical studies. 2,3Therefore, no inference can be made from our findings about the feasibility or clinical value of setting ventilatory pressure limits according to measures of pressure–volume curves in patients with acute respiratory distress syndrome.

In addition, we emphasize that we cannot take credit for “the desired impact on ventilatory strategy in critical care units” because this goal has been achieved by others in large, randomized clinical trials. 4,5Our study, however, provides evidence for an additional hypothesis; namely, that a combined treatment strategy, including the best available conventional management protocol and extracorporeal membrane oxygenation results in an improved survival rate for patients with acute respiratory distress syndrome.

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The Acute Respiratory Distress Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med [serial online]. March 10, 2000