Here is the design of a clinical trial:

Official Title: A Multicenter, Random Control Study: Early Use of Airway Pressure Release Ventilation Updated (APRVplus) Protocol in Acute Respiratory Disease Syndrome (ARDS)

Included conditions:
- Acute Respiratory Distress Syndrome

Study Armgroups:
- {'label': 'Early use of APRVplus protocol in ARDS', 'type': 'EXPERIMENTAL', 'description': 'physiology-driven APRVplus protocol', 'interventionNames': ['Procedure: APRVplus protocol']}
- {'label': 'Low tidal volume ventilation', 'type': 'OTHER', 'description': 'Low tidal volume lung protective ventilation', 'interventionNames': ['Procedure: Low tidal volume ventilation']}

Interventions:
- {'type': 'PROCEDURE', 'name': 'APRVplus protocol', 'description': 'Physiology-driven APRVplus protocol', 'armGroupLabels': ['Early use of APRVplus protocol in ARDS']}
- {'type': 'PROCEDURE', 'name': 'Low tidal volume ventilation', 'description': 'Low tidal volume lung protective ventilation', 'armGroupLabels': ['Low tidal volume ventilation']}

Primary Outcomes:
- {'measure': 'mortality', 'description': 'mortality at Day28', 'timeFrame': 'Day 28'}

Please estimate the sample size based on the assumption: 
90% power, two-sided significance level of 0.05, and approximately 10% loss in follow-up.
Sample size
          Based on previous research indicating a 37% mortality rate at ICU 28 days among moderate-severe ARDS patients receiving low tidal volume ventilation strategy [41], we postulated a 10% reduction in ICU 28-day mortality following the implementation of the early pathophysiology-directed APRV ventilation strategy compared to low tidal volume lung protective ventilation. Considering a hazard ratio of 0.66, a 90% power, and a two-sided significance level of 0.05, it is estimated that 762 patients are required to detect this difference. Accounting for approximately 10% loss in follow-up, enrollment of 840 patients (420 in each group) is necessary. An interim analysis will be conducted once 50% of the sample size is reached.
          
Table 2Overview of the schedule of enrolment, interventions and assessmentsAPRV airway pressure release ventilation, LTV low tital ventilation