The purpose of this research is to evaluate a different way of using the mechanical ventilator device to help better protect the lungs while the patient recovers. We will compare VentCoach to the current standard mechanical ventilation techniques used in our Intensive Care Units.

Inclusion Criteria:

• Patients with acute hypoxemic and/or hypercapnic respiratory failure.
• Patients requiring intubation and mechanical ventilation for more than 24 hours.
• VentCoach protocol is specific to volume controlled continuous mandatory ventilation (S-CMV).
• Patient who are admitted to RMH 10-3/10-4 and MB 6BGF ICUs.
• Age greater than or equal to 18 years.
• Patient's legal representative should be able to provide informed consent to the study. Any participant speaking any language will be offered participation.

Exclusion Criteria:

• Intubation and mechanical ventilation for airway protection in the setting of procedures/surgeries, e.g. interventional radiology, surgery, or endoscopy.
• Intubation and mechanical ventilation due to drug overdose with expected extubation of less than 24 hours.
• Intubation and mechanical ventilation in the setting of cardiac arrest.
• Intubation and mechanical ventilation for a primary neurological etiology, e.g. increased intracranial pressure, tumor mass effect, ischemic/hemorrhagic stroke, status epilepticus, etc.
• Mechanical ventilation to be guided by esophageal balloon.
• Subject deprived of freedom, minor, subject under a legal protective measure.
• Change in end-of-life decision anticipated after enrollment (or estimated 6-month mortality rate of greater than 50%).

Note: prone positioning is not a contraindication for participation.