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Pigs were randomized to three groups and ventilated for 12\u2009hours: PEEP set at \u22643% of overdistention (low overdistention), \u22643% of collapse (low collapse), and the crossing point of collapse and overdistention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Thirty-six pigs (12 per group) were included. Median (interquartile range) values of PEEP were 7 (6\u20138), 11 (10\u201311), and 15 (12\u201316) cm H2O in the three groups (P\u2009&amp;lt;\u20090.001). With low overdistension, 6 (50%) pigs died, whereas survival was 100% in both other groups. Cause of death was hemodynamic in nature, with high transpulmonary vascular gradient and high epinephrine requirements. Compared with the other groups, pigs surviving with low overdistension had worse respiratory mechanics and gas exchange during the entire protocol. Minimal differences existed between crossing-point and low-collapse animals in physiological parameters, but postmortem alveolar density was more homogeneous in the crossing-point group. Inflammatory markers were not significantly different.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PEEP to minimize overdistention resulted in high mortality in an animal model of ARDS. Minimizing collapse or choosing a compromise between collapse and overdistention may result in less lung injury, with potential benefits of the compromise approach.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202310-1895oc","type":"journal-article","created":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T12:20:31Z","timestamp":1707913231000},"page":"1441-1452","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":38,"title":["Limiting Overdistention or Collapse When Mechanically Ventilating Injured Lungs: A Randomized Study in a Porcine Model"],"prefix":"10.1093","volume":"209","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4236-5107","authenticated-orcid":false,"given":"Mayson L. 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