Avalanche Phenomenon During Airways Opening in Acute Respiratory Distress Syndrome

Inclusion Criteria

• •Age ≥ 18
• •Moderate-to-severe acute respiratory distress syndrome within the first 72 hours after meeting the Berlin definition criteria:
• •Within 1 week of a known clinical insult or new or worsening respiratory symptoms;
• •Bilateral opacities (not fully explained by effusions, lobar/lung collapse, or nodules);
• •Respiratory failure not fully explained by cardiac failure or fluid overload;
• •PaO2/FiO2 ≤ 200 mmHg with positive end-expiratory pressure ≥ 5 cmH2O.
• •Absence of spontaneous breathing efforts
• •Consent to participate to the study from the patient and/or its surrogate