Currently, clinical practice regarding positive end expiratory pressure (PEEP) strategies for Acute Respiratory Distress Syndrome (ARDS) revolves around two PEEP/FIO2 algorithms developed NHLBI research ARDSnet program. These two algorithms are known as the "High" PEEP/ lower FIO2 and "Low" PEEP/ higher FIO2 protocols. The High PEEP/ lower FIO2 protocol is seen as aggressive or the highest PEEP level a clinician would want to set, while the low PEEP/ higher FIO2 is seen as lowest PEEP level a clinician would set. While many studies have demonstrated safety and efficacy of a PEEP setting based on a required fraction of inspired oxygen (FIO2) to maintain adequate oxygenation, yet there are equal outcomes between the two strategies. There is growing evidence that the Low PEEP/ higher FIO2 protocol leaves large proportions of the lung derecruited and the High PEEP/FIO2 protocol may create overdistension in the compliant sections of the lung that are largely free from disease as it uses a single gas exchange (oxygenation) parameter to determine PEEP settings.