To the Editor: The absence of benefits observed by Pepe et al. (Aug. 2 issue)1 in the prevention of the adult respiratory-distress syndrome by early application of prophylactic positive end-expiratory pressure (PEEP) and the editorial in the same issue could be misleading to the practicing critical-care physician. The failure of early PEEP to provide any significant protection in the high-risk group is no surprise to us, since the pathogenesis of this syndrome is complex and still not completely understood. It seems illogical to expect that by merely maintaining pressures of 8 cm H2O in the airways at the.
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