Transpulmonary Pressure-guided Mechanical Ventilation Strategy in Right Ventricular Protection in Patients With ARDS

To verify whether the transpulmonary pressure-guided mechanical ventilation strategy can reduce right ventricular involvement, especially the incidence of acute cor pulmonale (ACP), in patients with moderate to severe ARDS induced by pneumonia compared with the currently widely used right ventricular protective mechanical ventilation strategy.

Inclusion Criteria: 1. Age ≥ 18 years old 2. ARDS caused by pneumonia (New Global Definition of ARDS) 3. PaO2/FiO2≤200mmHg 4. Received invasive mechanical ventilation 5. Sign the informed consent form Exclusion Criteria: 1. Invasive mechanical ventilation duration \> 48 hours 2. History of pulmonary hypertension caused by various reasons 3. Severe arrhythmia 4. BMI\>30kg/m2 5. Contraindications to inserting an esophageal catheter (including recent esophageal injury or surgery, severe coagulopathy (platelets \< 5×10⁹/L or INR \> 4) 6. Pregnant and lactating women 7. Lung transplant recipient 8. High-risk factors for increased intracranial pressure (including intracranial hemorrhage, cerebral contusion, cerebral edema, intracranial space-occupying lesions, etc.) 9. Active air leakage in the lungs (pneumothorax, mediastinal emphysema, bronchopleural fistula, air leakage from closed thoracic drainage tubes, etc.) 10. Neuromuscular disease 11. Already received salvage measures (iNO, ECMO, prone position, high-frequency oscillatory ventilation) 12. Severe liver failure 13. Participated in other ARDS-related studies within 30 days