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Objectives To provide proof-of-concept for a protocol applying a strategy of personalized mechanical ventilation in children with acute respiratory distress syndrome. Positive end-expiratory pressure and inspiratory pressure settings were optimized using real-time electrical impedance tomography aiming to maximize lung recruitment while minimizing lung overdistension. Design Prospective interventional trial. Setting Two PICUs. Patients Eight children with early acute respiratory distress syndrome ( less then 72 hr). Interventions On 3 c