Do higher PEEP levels improve outcomes in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)? The EXPRESS trial examined the optimal setting of positive end-expiratory pressure (PEEP) in patients with ALI and ARDS. This multicenter, randomized controlled trial (RCT) compared high versus low levels of PEEP in patients receiving mechanical ventilation. The study found that higher levels of PEEP improved oxygenation and reduced the need for additional interventions, including prone positioning, but it did not result in improved survival rates. The increased recruitment strategy reduced the time spent on mechanical ventilation; moreover, organ failures were also lower. Oxygenation and respiratory system compliance were also significantly better with the increased recruitment strategy. Suggesting that while it may benefit some aspects of respiratory function, it does not necessarily confer a survival advantage in this patient population.