Acute Respiratory Distress Syndrome Management and Outcomes

Acute Respiratory Distress Syndrome (ARDS) remains a critical challenge in intensive care medicine, characterised by rapid onset of non-cardiogenic pulmonary oedema, severe hypoxaemia and diffuse inflammation. Management has evolved from uniform high-volume ventilation towards lung-protective strategies using lower tidal volumes, conservative fluid balance and individualised positive end-expiratory pressure. Prone positioning has emerged as a standard adjunct to improve oxygenation, while extracorporeal membrane oxygenation (ECMO) offers rescue support in refractory cases. Beyond supportive care, attention has shifted to the underlying heterogeneity of ARDS, with efforts to identify inflammatory and physiological phenotypes that predict treatment response. Outcome has improved modestly but remains poor in severe cases, with mortality rates approaching 40 per cent. Early recognition, stratification by oxygenation indices and tailored interventions are essential. Advances in bedside decision tools and risk modelling promise more precise application of ventilation modalities, fluid management and emerging therapies, ultimately aiming to reduce ventilator-associated injury and multi-organ dysfunction.

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Acute Respiratory Distress Syndrome Management and Outcomes publication trend

The graph below shows the total number of articles in acute respiratory distress syndrome management and outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

ARDS: A syndrome of acute hypoxaemic respiratory failure caused by diffuse lung inflammation and non-cardiogenic pulmonary oedema.

PaO2/FiO2 ratio: The arterial oxygen partial pressure divided by the fraction of inspired oxygen, used to stratify ARDS severity.

Mechanical ventilation: The use of a machine to support or replace spontaneous breathing by delivering air or oxygen under positive pressure.

Prone positioning: Placing a patient face-down to improve ventilation–perfusion matching and reduce ventilator-induced lung injury.

Extracorporeal membrane oxygenation (ECMO): A technique that circulates blood through an artificial lung for gas exchange, used in severe respiratory failure.

References

1. Advances in acute respiratory distress syndrome: focusing on heterogeneity, pathophysiology, and therapeutic strategies. Signal Transduction and Targeted Therapy (2025).
2. Collaborative strategies for deploying artificial intelligence to complement physician diagnoses of acute respiratory distress syndrome. npj Digital Medicine (2023).