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Related Experiment Video

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Lung-morphology-guided mechanical ventilation in ARDS patients.

Elina Nazarian1, Lieuwe D J Bos1,2,3, Marry R Smit1

  • 1Department of Intensive Care.

Current Opinion in Critical Care
|January 2, 2026
PubMed
Summary

Accurate acute respiratory distress syndrome (ARDS) lung morphology classification is key for effective mechanical ventilation. Lung ultrasound (LUS) shows promise for bedside use, guiding personalized ventilation strategies.

Keywords:
acute respiratory distress syndromelung morphologymechanical ventilationpersonalized medicinesubphenotyping

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Area of Science:

  • Pulmonary Medicine
  • Critical Care
  • Medical Imaging

Background:

  • Acute respiratory distress syndrome (ARDS) presents with distinct lung morphologies, focal and nonfocal.
  • These morphologies influence the effectiveness of mechanical ventilation strategies.

Purpose of the Study:

  • To review lung morphology classification in ARDS.
  • To explore morphology-guided mechanical ventilation strategies.
  • To discuss the role of imaging in identifying ARDS subphenotypes.

Main Methods:

  • Review of existing literature on ARDS morphology classification.
  • Discussion of computed tomography (CT) and lung ultrasound (LUS) imaging techniques.
  • Analysis of ventilation strategies tailored to lung morphology.

Main Results:

  • CT imaging differentiates ARDS morphologies, impacting responses to positive end-expiratory pressure (PEEP) and recruitment maneuvers.
  • The LIVE trial demonstrated that misclassification can negate survival benefits of personalized ventilation.
  • Lung ultrasound (LUS) is emerging as an accurate, noninvasive tool for ARDS morphology classification.

Conclusions:

  • Precise lung morphology assessment is crucial for guiding mechanical ventilation in ARDS.
  • Lung ultrasound (LUS) offers a promising bedside approach for morphology-guided ventilation.
  • Further validation of LUS for clinical benefit in ARDS management is warranted.