EIT-Guided Ventilator Settings in AHRF

Inclusion Criteria: * Age ≥ 18 years * Diagnosed with acute hypoxemic respiratory failure within 48 hours * Expected to require invasive mechanical ventilation ≥ 48 hours * On mechanical ventilation within 24 hours * Deep sedation and neuromuscular blockade Exclusion Criteria: * Pregnancy * Body mass index (BMI) \> 40 kg/m2 * Contraindications to using electrical impedance tomography, including * Presence of a pacemaker or automatic implantable cardioverter-defibrillator (AICD) * Inability to place the belt due to presence of surgical wounds dressing, thoracic or spinal cord trauma, recent thoracic surgery, etc. * High risk for PEEP titration * Hemodynamic instability defined as mean arterial pressure \< 65 mmHg despite optimization of fluid status and/or use of vasopressors * Unstable cardiac arrhythmias * Presence of lung bullae greater than 2 cm in diameter, identified on chest X-ray * Presence of pneumothorax or pneumomediastinum * Right-sided heart failure or severe pulmonary hypertension * Neurologic conditions associated with a risk of intracranial hypertension * Use of extracorporeal membrane oxygenation (ECMO) * Severe chronic respiratory disease, defined as follows: requiring home oxygen therapy, or previous lung function showing (FEV1 less than 20 ml/kg PBW, or FEV1/FVC less than 50% predicted value), or chronic hypercapnia (PaCO2 greater than 45 mmHg) and/or chronic hypoxemia (PaO2 less than 55 mmHg) on FIO2 = 0.21, or radiographic x-ray evidence of any chronic…