“…However, in patient with ARDS related to intra-abdominal disease and in those exhibiting high BMI, the chest wall may account for a much higher proportion of total elastance [14,15]. In accordance with those observations, Grasso et al [5] suggested that targeting Pplat of 30 cmH 2 O may be excessively prudent in some patients and may lead to unjustified recommendations for ECMO management. On the other hand, Terragni et al [16] showed in 30 patients managed according to the ARDS network strategy that one-third experienced tidal hyperinflation [assessed by CT scan systematic analysis] despite a Vt of 6 ml/kg PBW and a Pplat limited at 30 cmH 2 O.…”