Full Stage Lay Summary Acute respiratory distress syndrome (ARDS) is a condition where the lungs have become injured and do not work as they normally do to provide oxygen and remove carbon dioxide from the body. This leads to reduced oxygen in the blood. Patients with ARDS are admitted to the intensive care unit (ICU) and require help with their breathing by way of a mechanical ventilator (breathing machine). ARDS can cause damage to other organs and death. Recently a ventilator strategy using an occasional sustained deep breath (the PHARLAP strategy) has been shown, in a small study, to have some benefits compared to current best recommended care. The PHARLAP strategy increased blood oxygen levels and reduced markers of inflammation in the body. A larger study of 340 patients in multiple ICUs across New Zealand and Australia will be undertaken aimed at decreasing the number of days on mechanical ventilation required by these patients.