There is plenty of data on using low tidal volumes (VT) on patients with ARDS. What about the optimum PEEP strategy? Recent Meta-analysis from “Annals of Internal Medicine” did not find any mortality benefit from higher PEEP. I am usually dialing PEEP up as I am decreasing FiO2. It’s not unusual to have somebody with bad ARDS on 17.5 of PEEP or even higher. There is no evidence that higher PEEP hurts patients, though, how high is to high is still unclear.