We can now add SimVA to create an immersive simulated case of a severe ARDS from intubation to PEEP titration, with protective ventilation, driving pressure, compliance, alveolar recruitment, end expiratory lung volume, spirodynamic, transpulmonary pressure, under VAC or PAC. With arterial oxygenation, end Tidal CO2, hemodynamic effects, arterial blood gases. We can switch to spontaneous breathing, pressure support ventilation, patient ventilator interaction after severe ARDS with premature cycling, double cycling, inspiratory effort assessment, Electrical Activity of the Diaphragm, Proportional assist modes.