{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:18:48Z","timestamp":1792513128024,"version":"4.5.0"},"reference-count":90,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Distributive shock and acute respiratory distress syndrome (ARDS) are syndromes of profound pathophysiological complexity, each independently associated with high morbidity and mortality. When coexistent, they create a state of synergistic cardiopulmonary failure where conventional, protocolized management approaches are often insufficient. This review synthesizes current mechanistic insights into heart\u2013lung interactions in distributive shock with ARDS, highlighting the central role of right ventricular\u2013pulmonary arterial coupling and the dual impact of altered lung mechanics and vascular dysregulation. We examine the distinct hemodynamic implications of pulmonary versus extrapulmonary ARDS phenotypes, including their divergent effects on transpulmonary pressure, venous return, and right ventricular afterload, and emphasize the clinical relevance of mixed phenotypes. Advanced monitoring modalities\u2014esophageal manometry, echocardiography, and, in select cases, pulmonary artery catheterization\u2014are presented as essential tools for dynamic phenotyping and individualized titration of ventilatory and hemodynamic strategies. Building on these principles, we outline phenotype-directed approaches to ventilation, fluid and vasoactive therapy, and adjunctive interventions such as proning and extracorporeal support. Finally, we discuss knowledge gaps and future directions, underscoring the need for integrative technologies and phenotype-stratified trials to refine precision management. The nuanced integration of cardiopulmonary physiology into bedside decision-making represents a paradigm shift toward individualized, physiology-guided care for this high-risk population.<\/jats:p>","DOI":"10.3390\/jcm14217844","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T17:06:06Z","timestamp":1762362366000},"page":"7844","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Heart\u2013Lung Interactions in Combined Distributive Shock and ARDS: Applied Cardiopulmonary Physiology at the Bedside"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7634-4665","authenticated-orcid":false,"given":"Athanasios","family":"Chalkias","sequence":"first","affiliation":[{"name":"Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-5158, USA"},{"name":"OUTCOMES RESEARCH Consortium<sup>\u00ae<\/sup>, Houston, TX 77030, USA"},{"name":"Department of Critical Care Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantina","family":"Katsifa","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavroula","family":"Amanetopoulou","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Karapiperis","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3623-4514","authenticated-orcid":false,"given":"Christos","family":"Tountas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sismanogleio General Hospital, 15126 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikoleta","family":"Ntalarizou","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Prekates","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paraskevi","family":"Tselioti","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1001\/jama.2016.0291","article-title":"Epidemiology, Patterns of Care, and Mortality for Patients with Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries","volume":"315","author":"Bellani","year":"2016","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: Analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Acute Respiratory Distress Syndrome Network, Brower, R.G., Matthay, M.A., Morris, A., Schoenfeld, D., Thompson, B.T., and Wheeler, A. 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