A personalized approach to the acute respiratory distress syndrome: recent advances and future challenges

Since its very first description, understanding the acute respiratory distress syndrome (ARDS) has been a major research and clinical challenge due to heterogeneity in causes, manifestations, physiologic derangements and response to treatment. Recently, growing evidences on the mechanisms underlying ARDS pathophysiology and randomized trials yielding negative results generated a worldwide collaborative effort to define more homogenous subgroups of ARDS subjects and titrate personalized interventions. A recently published trial (the LIVE study) tried to maximize this effort and compared for the first time personalized vs. conventional protective ventilation strategies (1). In the present article, we describe how ventilation in ARDS could be personalized based on sound pathophysiological subgroups and comment the results from the LIVE study.