This is a case of Acute Respiratory Distress Syndrome managed using esophageal balloon catheter to adjust inspiratory pressure and positive end expiratory pressure according to the inspiratory and expiratory transpulmonary pressures. There are no studies that examine the transpulmonary pressures in airway pressure release ventilation (APRV). We aimed to test the feasibility of using the esophageal balloon in the nonconventional mode of APRV. All pressures were observed when switching the mode from a pressure-controlled mode to APRV using the same inspiratory pressure and using various incremental release times (TLow)to calculate the expiratory transpulmonary pressure. At all TLow levels the transpulmonary pressure at end exhalation was in the negative value indicating alveolar collapse. A larger study is needed to confirm our findings and to help guide setting APRV.