Spinal Cord Stimulation to Shorten Ventilator Dependence in ARDS Patients

Inclusion Criteria: 1. Male or female 18-85 years; 2. Intubated with confirmed diagnosis of ARDS (by Berlin Criteria: acute onset within one week of known insult, bilateral airspace opacities not fully explained by pleural effusions, atelectasis, and/or nodules, respiratory failure not explained by heart failure or fluid overload, PaO2/FiO2 ratio \< 300); or identified as a patient admitted to the intensive care unit (ICU) after non-cardiac surgery; 3. Able to provide informed consent or available next of kin able to provide informed consent; 4. Have intact chest/lung, upper and lower extremity anatomy; 5. The neuromuscular connections between the spinal cord, diaphragm, and intercostal muscles are intact; 6. Enrollment of subject within 48 hours of intubation; 7. Able to induce evoked response of diaphragm muscle by spinal cord TES. Exclusion Criteria: 1. Phrenic nerve or diaphragm pacer; 2. History of seizure disorder or on anti-epileptic medication for the treatment of seizures; 3. Compromised skin in back (neck, upper and lower back); 4. Pregnancy; 5. Implanted devices: cardiac pacemakers, implanted defibrillators, implanted neurostimulators, phrenic nerve pacers; 6. BMI greater than or equal to 35; 7. Pharmacological paralysis/neuromuscular blockade\*.