inclusion criteria for enrollment covid-19 diagnosed by pcr within 3 weeks men and women any race/ethnicity 18-65 years of age endotracheal tube or tracheostomy in place and mechanically ventilated for < 7 days; radiologic evidence of bilateral pulmonary infiltrates not fully explained by hydrostatic pulmonary edema access to an lar to provide consent (remote consent is permissible). additional inclusion criteria required for randomization: meet all inclusion/exclusion criteria for enrollment have a p/f ratio <200 with peep ≥8 cm h2o either from abg or imputed from spo2 as described by brown et al (chest 2016; 150:307).

inclusion criteria for enrollment covid-19 diagnosed by pcr within 3 weeks men and women any race/ethnicity 18-65 years of age endotracheal tube or tracheostomy in place and mechanically ventilated for < 7 days; radiologic evidence of bilateral pulmonary infiltrates not fully explained by hydrostatic pulmonary edema access to an lar to provide consent (remote consent is permissible). additional inclusion criteria required for randomization: meet all inclusion/exclusion criteria for enrollment have a p/f ratio <200 with peep ≥8 cm h2o either from abg or imputed from spo2 as described by brown et al (chest 2016; 150:307).

inclusion criteria for enrollment 1. covid-19 diagnosed by pcr within 3 weeks 2. men and women 3. any race/ethnicity 4. 18-65 years of age 5. endotracheal tube or tracheostomy in place and mechanically ventilated for < 7 days; 6. radiologic evidence of bilateral pulmonary infiltrates not fully explained by hydrostatic pulmonary edema 7. access to an lar to provide consent (remote consent is permissible). additional inclusion criteria required for randomization: 1. meet all inclusion/exclusion criteria for enrollment 2. have a p/f ratio <200 with peep ≥8 cm h2o either from abg or imputed from spo2 as described by brown et al (chest 2016; 150:307).

inclusion criteria for enrollment 1. covid-19 diagnosed by pcr within 3 weeks 2. men and women 3. any race/ethnicity 4. 18-65 years of age 5. endotracheal tube or tracheostomy in place and mechanically ventilated for < 7 days; 6. radiologic evidence of bilateral pulmonary infiltrates not fully explained by hydrostatic pulmonary edema 7. access to an lar to provide consent (remote consent is permissible). additional inclusion criteria required for randomization: 1. meet all inclusion/exclusion criteria for enrollment 2. have a p/f ratio <200 with peep ≥8 cm h2o either from abg or imputed from spo2 as described by brown et al (chest 2016; 150:307).