Mechanical ventilation in acute respiratory distress syndrome at ATS 2016: the search for a patient-specific strategy

Acute respiratory distress syndrome (ARDS) was first defined by Ashbaugh et al. in 1967 (1). They described 12 patients who developed the acute onset of hypoxemic respiratory failure, diffuse bilateral alveolar infiltrates, and low respiratory system compliance brought on by a variety of different insults. Decades of dedicated research have followed this initial description, yet ARDS remains a common critical illness with an exceptionally high mortality rate of 35–46% (2). At the 2016 American Thoracic Society (ATS) International Meeting, Dr. Brian Kavanagh, a Professor of Anesthesia from the University of Toronto, delivered a highly popular keynote speech addressing the role professional societies play in promoting universal management guidelines. He made several important points about the challenges and possible downsides to this strategy. This article reviews the potential for a more patient-specific approach to ARDS care based on presentations at the ATS meeting and the recent literature.