New ventilation technique tested in ICU patients with severe lung failure

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

Inclusion Criteria: * 18 years or older * Provided written informed consent * Undergoing controlled mechanical ventilation via an endotracheal tube * Meeting all criteria of the Berlin definition of ARDS * Hypoxic respiratory failure within 1 week of a known clinical insult or new or worsening respiratory symptoms * Bilateral opacities on X-ray or CT-scan not fully explained by effusions, lobar/lung collapse (atelectasis), or nodules * Respiratory failure not fully explained by cardiac failure or fluid overload. * Oxygenation: moderate ARDS P/F ratio between 101-200 mmHg, severe ARDS PF ratio ≤ 100mmHg, both with PEEP ≥ 5 cmH2O. * Intubated ≤72 hours Exclusion Criteria: * Severe sputum stasis or production requiring frequent bronchial suctioning (more than 5 times per nurse shift) * Untreated pneumothorax (i.e., no pleural drainage) * Hemodynamic instability defined as a mean arterial pressure below 60mmHg not responding to fluids and/or vasopressors or a noradrenalin dose \>0.5mcrg/kg/min * High (\>15 mmHg) or instable (an increase in sedation or osmotherapy is required) intracranial pressure * An inner tube diameter of 6mm or less * Intubated \> 72 hours * Anticipating withdrawal of life support and/or shift to palliation as the goal of care * Inability to perform adequate electrical impedance tomography (EIT) measurements with, e.g.: * Have a thorax circumference inappropriate for EIT-belt * Thoracic wounds, bandages or deformities preventing adequate fit of EIT-belt * Recent (\<7 days) pulmonary surgery including pneumonectomy, lobectomy or lung transplantation * ICD device present (potential interference with proper functioning of the EIT device and ICD device) * Excessive subcutaneous emphysema * Contra-indications for nasogastric tube or inability to perform adequate transpulmonary pressure measurements with, e.g.: * Recent esophageal surgery * Prior esophagectomy * Known presence of esophageal varices * Severe bleeding disorders