Ventilator-induced lung injury is a common therapeutic side effect of acute respiratory distress syndrome and is an unfavourable factor of prognosis. The currently clinically used indicators, plateau pressure and tidal volume, are effective but not perfect to indicate and prevent VILI. This research demonstrates that the transpulmonary driving pressure is a more accurate and correlating factor of the incidence of VILI, and that the current approach of limiting plateau pressure should not be unanimously applied to patients with and patients without Intra-abdominal hypertension.