Inclusion Criteria:  Patients aged > 18 years, who were followed up in the Intensive Care Unit (ICU) with mechanical ventilation support and diagnosed with ARDS according to the Berlin criteria, and SpO2 ≤ 92%, were included in the study  Exclusion Criteria:  Patients younger than 18 years old, with an increased requirement for inotropic medication in the last 2 hours or with a mean arterial pressure < 65 mmHg, and those with intracranial hypertension, acute coronary syndrome, hypercapnia, pneumothorax, subcutaneous emphysema, and pneumomediastinum were excluded from the study.