Gross lung photos with corresponding driving pressure (ΔP), tidal volume (Vt), and respiratory system compliance (CRS) values over time . Two protective mechanical ventilation strategies, the TCAV method (a) and the ARDSNet (LVt) method (b), were tested in a clinically applicable 48-h porcine ARDS model of peritoneal sepsis (PS) and gut ischemia/reperfusion (I/R) injury . The evolution of CRS, ΔP, and Vt with time in each group occurred over the 48-h study period (c, d). In the ARDSNet LVt method group, ΔP increased despite the reduction in Vt because of worsening CRS. With the TCAV method, ΔP remained low despite Vt = ~ 12 ml/kg because CRS progressively increased (c, d). The personalized and adaptive Vt based on lung CRS (i.e., high CRS = large Vt and low Crs = small Vt) was also seen in the brain-dead organ donor (Fig. 5a). Gross lung photos illustrate that the TCAV method (a) was lung protective, whereas the LVt method (b) resulted in severe acute lung injury. ΔP was calculated retrospectively and was not in the publication by Roy et al.