Can adjusting breathing effort during ventilation improve lung function in ARDS?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * 1\. Age ≥18 and ≤80 years old. 2. Diagnosed with moderate-to-severe ARDS according to the 2023 global ARDS definition. 3\. Within 48 hours of invasive mechanical ventilation. After 1-hour low-tidal-volume pressure-controlled ventilation following ARDSnet strategy, arterial blood gas shows PaO₂/FiO₂ ≤ 150 mmHg. 4\. Written informed consent is obtained from the patient or their legal surrogate decision-maker after full explanation of the study by the principal investigator or authorized study physician. Exclusion Criteria: * 1\. Refractory shock defined as persistent hyperlactatemia and/or prolonged capillary refill time, fluid-resistant, requiring norepinephrine ≥ 0.5 μg/kg/min. 2\. Severe chronic medical conditions severely affecting cardiopulmonary function: severe chronic obstructive pulmonary disease, interstitial lung disease, pulmonary embolism, right-heart failure, pulmonary hypertension, or severe arrhythmia. 3\. Radiologically confirmed bronchopleural fistula, status post lobectomy, or other major thoracic surgery. 4\. Contraindications to electrical impedance tomography (EIT): extensive chest skin injury or infection, implanted cardiac pacemaker or defibrillator, etc. 5\. Contraindications for esophageal manometry placement: esophageal obstruction, perforation, severe esophageal varices, etc. 6\. Diaphragmatic hernia, severe chest wall deformity, or significant pulmonary bullae. 7\. Significant coagulation abnormalities (PT or APTT prolonged ≥2 times upper limit of normal, or INR\>2.0) with active bleeding risk. 8\. Severe intracranial hypertension (\>20 mmHg), severe traumatic brain injury (GCS ≤8), or neuromuscular disorders. 9\. Pregnant or breastfeeding women. 10. Patients already receiving ECMO therapy. 11. Expected survival time \<24 hours judged by attending physician. 12. Body mass index (BMI) \>35 kg/m². 13. Previously enrolled in this study or participating in other interventional clinical trials.