Airway Pressure Release Ventilation as a Preventative Strategy

Inclusion Criteria: * Trauma patients age 16 or older * Trauma patients requiring ventilatory support within 48 hours of injury * Those with anticipated ventilatory support ≥ 24 hours * Subject or authorized representative (AR) has signed an informed consent form (ICF) * Subjects age 16 or 17 who have signed an assent document and/or AR has signed an ICF Exclusion Criteria: * Significant chronic lung disease defined as lung pathology requiring home O2 use * Chronic heart disease defined as NYHC III or higher * Persistent bronchopulmonary air leak * Contraindications to permissive hypercapnia (ex. Intracerebral bleeding, brain tumor, fulminant hepatic failure, and hemodynamic instability) * Pulmonary artery occlusion pressures ≥ 18 mmHg * Severe neurologic injury that may prevent the patient from having a reasonable opportunity for weaning as determined by the clinical study team * Immuno-compromised patients secondary to drugs or disease * Neuromuscular disease that impairs ability to ventilate spontaneously (ex. Spinal injury at or above C5, ALS, Guillain-Barre syndrome, Myasthenia Gravis) * History of pneumonectomy * Pregnancy * Burns with TBSA ≥ 20% * Acute MI as the cause of ALI/ARDS * All other contraindications to APRV * Patients who cannot be randomized within 12 hours of intubation