[Acute lung failure]

Acute respiratory distress syndrome (ARDS) represents one of the most complex clinical entities in intensive care medicine and confronts clinicians with novel challenges daily due to its heterogeneity. With a mortality rate of 35-45%, it remains a significant clinical challenge; however, current developments offer promising therapeutic options.Contemporary ARDS management continues to evolve: parameters such as driving pressure and mechanical power complement established lung-protective ventilation concepts and enable more precise therapeutic control. Transpulmonary pressure measurement supports individualized PEEP titration, while automated closed-loop systems can significantly extend time within lung-protective ranges.Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has established itself as an important rescue therapy and received conditional recommendation for the first time in the new S3 guideline 2025. Ultra-protective ventilation strategies under ECMO enable substantial reduction of mechanical stress and support the concept of "lung rest".From epidemiology and pathophysiology to novel disease entities such as EVALI and innovative monitoring procedures, this review article provides a current overview of the syndrome's fundamentals as well as modern diagnostics and therapy of ARDS, and demonstrates how these insights can be beneficially implemented in daily clinical practice.