A narrative review on the future of ARDS: evolving definitions, pathophysiology, and tailored management
Issued Date
2025-12-01
Resource Type
ISSN
13648535
eISSN
1466609X
Scopus ID
2-s2.0-85218447776
Journal Title
Critical Care
Volume
29
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Critical Care Vol.29 No.1 (2025)
Suggested Citation
Al-Husinat L., Azzam S., Al Sharie S., Araydah M., Battaglini D., Abushehab S., Cortes-Puentes G.A., Schultz M.J., Rocco P.R.M. A narrative review on the future of ARDS: evolving definitions, pathophysiology, and tailored management. Critical Care Vol.29 No.1 (2025). doi:10.1186/s13054-025-05291-0 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/105490
Title
A narrative review on the future of ARDS: evolving definitions, pathophysiology, and tailored management
Author's Affiliation
Mahidol Oxford Tropical Medicine Research Unit
University Hospitals Bristol and Weston NHS Foundation Trust
IRCCS San Martino Polyclinic Hospital
Istishari Hospital, Amman
King Hussein Cancer Center
Yarmouk University
Università degli Studi di Genova
Medizinische Universität Wien
Nuffield Department of Medicine
Mayo Clinic
Amsterdam UMC - University of Amsterdam
Universidade Federal do Rio de Janeiro
University Hospitals Bristol and Weston NHS Foundation Trust
IRCCS San Martino Polyclinic Hospital
Istishari Hospital, Amman
King Hussein Cancer Center
Yarmouk University
Università degli Studi di Genova
Medizinische Universität Wien
Nuffield Department of Medicine
Mayo Clinic
Amsterdam UMC - University of Amsterdam
Universidade Federal do Rio de Janeiro
Corresponding Author(s)
Other Contributor(s)
Abstract
Acute respiratory distress syndrome (ARDS) is a severe complication of critical illness, characterized by bilateral lung infiltrates and hypoxemia. Its clinical and pathophysiological heterogeneity poses challenges for both diagnosis and treatment. This review outlines the evolution of ARDS definitions, discusses the underlying pathophysiology of ARDS, and examines the clinical implications of its heterogeneity. Traditional ARDS definitions required invasive mechanical ventilation and relied on arterial blood gas measurements to calculate the PaO2/FiO2 ratio. Recent updates have expanded these criteria to include patients receiving noninvasive respiratory support, such as high-flow nasal oxygen, and the adoption of the SpO2/FiO2 ratio as an alternative to the PaO2/FiO2 ratio. While these changes broaden the diagnostic criteria, they also introduce additional complexity. ARDS heterogeneity—driven by varying etiologies, clinical subphenotypes, and underlying biological mechanisms—highlights the limitations of a uniform management approach. Emerging evidence highlights the presence of distinct ARDS subphenotypes, each defined by unique molecular and clinical characteristics, offering a pathway to more precise therapeutic targeting. Advances in omics technologies—encompassing genomics, proteomics, and metabolomics—are paving the way for precision-medicine approaches with the potential to revolutionize ARDS management by tailoring interventions to individual patient profiles. This paradigm shift from broad diagnostic categories to precise, subphenotype-driven care holds promise for redefining the landscape of treatment for ARDS and, ultimately, improving outcomes in this complex, multifaceted syndrome.