Jon-Emile S. Kenny MD [@heart_lung] More than 20 years ago Amato and colleagues reported a significant mortality reduction in ARDS patients who had their ventilator settings guided by the pressure-volume [PV] curve [1]. The 28-day mortality reduction was profound - 71% versus 38% - in favour of the patients who had their positive end-expiratory pressure [PEEP] set 2 cm H2O above the lower inflection point [LIP] ascertained from the PV curve. In addition, the intervention group had their plateau pressure [Pplat] capped at 20 cm H2O. While this trial may have been practice-changing at the time, the unusually-high mortality rate for the conventional group [i.e. 71%] coupled with simultaneous titration of PEEP and Pplat precluded definitive implementation of PV-curve-based ventilator tuning [