To the Editor: The systematic review and meta-analysis by Dr Serpa Neto and colleagues1 found that protective ventilation with lower tidal volumes in patients without ARDS was associated with better outcomes. We have several methodological concerns with the study.
First, given the inclusion criteria, it is unclear how the authors excluded several important studies2,3 examining the role of tidal volume in the development of ARDS. In the study by Gajic et al4 that was included in the review, 80 patients developed lung injury, yet the authors included an assessment of only 44 patients in their meta-analysis. What happened to the other 36 patients who developed lung injury? Regarding the study by Fernandez-Bustamante et al,5 Serpa Neto et al claimed that 12 patients progressed to lung injury despite the fact that the original article stated that “no radiographic criteria were available to assess acute lung injury.”
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