inclusion criteria: - signed informed consent form by his or her legal/authorized representative - age ≥ 18 years at time of signing informed consent form - ability to comply with the study protocol, in the investigator's judgement - hospitalized with covid-19 pneumonia confirmed with world health organization (who) criteria (including an rna test of any specimen, e.g. respiratory, blood, urine, stool, other bodily fluid) and evidence by chest x-ray or ct scan - fraction of inspired oxygen (fi02) ≤ 0.40 and positive end-expiratory pressure (peep) ≤8 or fi02 ≤ 0.50 and peep ≤5 - fi02 and peep ≤ values of previous day - patient has acceptable spontaneous breathing efforts (may decrease vent rate by 50% for 5 minutes to detect effort.) - no neuromuscular blocking agents or blockade. - rass score initially at -3 ≤, rising to 3+ after initial attempt to wean from standard of care sedating medications - other investigational interventions may be permitted

inclusion criteria: - signed informed consent form by his or her legal/authorized representative - age ≥ 18 years at time of signing informed consent form - ability to comply with the study protocol, in the investigator's judgement - hospitalized with covid-19 pneumonia confirmed with world health organization (who) criteria (including an rna test of any specimen, e.g. respiratory, blood, urine, stool, other bodily fluid) and evidence by chest x-ray or ct scan - fraction of inspired oxygen (fi02) ≤ 0.40 and positive end-expiratory pressure (peep) ≤8 or fi02 ≤ 0.50 and peep ≤5 - fi02 and peep ≤ values of previous day - patient has acceptable spontaneous breathing efforts (may decrease vent rate by 50% for 5 minutes to detect effort.) - no neuromuscular blocking agents or blockade. - rass score initially at -3 ≤, rising to 3+ after initial attempt to wean from standard of care sedating medications - other investigational interventions may be permitted