BACKGROUND　　In the acute respiratory distress syndrome(ARDS)，positive end-expiratory pressure(PEEP)may decrease ventilator-induced lung injury by keeping lung regions open that otherwise would be collapsed．Since the effects of PEEP probably depend on the recruitability of lung tissue,we conducted a study to examine the relationship between the percentage of potentially recruitable lung，as indicated by computed tomography(CT),and the clinical and physiological effects of PEEP．

METHODS　　Sixty-eight patients with acute lung injury or ARDS under went whole-lung CT during breath-holding sessions at airway pressures of 5,15,and 45 cm of water．The percentage of potentially recruitable lung was defined as the proportion of lung tissue in which aeration was restored at airway pressure between 5 and 45 cm of water．

RESULTS　　The percentage of potentially recruitable lung varied widely in the population，accounting for a mean(±SD) of 13±11 percent of the lung weight，and was highly correlated with the percentage of lung tissue in which aeration was maintained after the application of PEEP(r2=0.72，P<0.001)，poorer oxygenation (defined as a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen)(P<0.001)and respirato-ry-system compliance(P=0.002)，higher levels of dead space(P=0.002)，and higher rates of death(P=0.02)than patients with a lower percentage of potentially recruitable lung．The combined physiological variables predicted，with a sensitivity of 71 percent and a specificity of 59 percent．whether a patient's proportion of potentially recruitable lung was higher or lower than the median．

CONCLUSIONS　　In ARDS．the percentage of potentially recruitable lung is extremely variable and is strongly asso-ciated with the response to PEEP．

(N Engl J Med 2006；354：1775-86．April 27，2006)