Jon-Emile S. Kenny MD [@heart_lung] “I am suffocated and lost when I have not the bright feeling of progression” -Margaret Fuller A recent letter and review in Critical Care have called for adoption of the ‘Open Lung Approach’ to patients with severe ARDS. More specifically, in refractory ARDS whilst prone, it is argued that esophageal manometry be used to guide an end-inspiratory trans-pulmonary pressure [Ptp - airway pressure less the estimated pleural pressure] of 25 cm H2O.