Clinical Decision Support Tool in PARDS Pilot Study

Inclusion Criteria: * Children \> 1 month of age and \>44 weeks gestation and ≤ 18 years of age AND * Supported on mechanical ventilation with pulmonary parenchymal disease (i.e. Pediatric Acute Respiratory Distress Syndrome (PARDS)) with Oxygen Saturation Index (OSI) ≥ 5) or Oxygenation Index (OI) ≥ 4 AND * Who are within 72 hours of initiation of invasive mechanical ventilation AND * Who are anticipated to require \>72 hours mechanical ventilation. Exclusion Criteria: * Conditions on enrollment that preclude conventional methods of weaning (i.e., status asthmaticus, severe lower airway obstruction, bronchiolitis, critical airway, Extra Corporeal Life Support (ECLS), intubation for Upper Airway Obstruction, Do Not Resuscitate orders, severe chronic respiratory failure, spinal cord injury above lumbar region, cyanotic heart disease (unrepaired or palliated)) OR * Conditions precluding the use of permissive hypercapnia or hypoxemia (i.e. intracranial hypertension, severe pulmonary hypertension) * Primary Attending physician refuses to enroll the patient