The extended lung protection with strict control of ΔP for moderate to severe ARDS plus deranged mechanics is feasible and could be implemented in this pilot study with some beneficial impact on the recovery of lung function.

Due to the early stopping of this study, we were not powered to assess the superiority of this strategy over the conventional low-PEEP/FIO2 ARDSnet strategy.

Nevertheless, some promising and positive secondary outcomes encourage the test of such protocol in a larger trial—or at least the implementation of parts of it in new studies. We did not observe any evident side effect of the proposed strategy.

Scientific Knowledge on the Subject: The importance of early protective ventilation strategies following ARDS diagnosis is well-established. These strategies involve application of low tidal volumes and driving pressures, limited plateau pressures and respiratory rates as well as prone positioning. However, the optimal duration of this lung protection has not been studied.

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