Clinical Research Directory

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.