{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T15:27:58Z","timestamp":1784820478752,"version":"3.55.0"},"reference-count":118,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Brazilian Council for Scientific and Technological Development","award":["0306599\/2023-6"],"award-info":[{"award-number":["0306599\/2023-6"]}]},{"name":"Rio de Janeiro State Research Foundation","award":["E-26\/210.338\/2022"],"award-info":[{"award-number":["E-26\/210.338\/2022"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Acute respiratory distress syndrome (ARDS) is a heterogeneous inflammatory lung injury marked by increased alveolar\u2013capillary permeability, reduced respiratory system compliance, and impaired gas exchange. Despite advances in supportive care, ARDS remains associated with high mortality. Lung-protective ventilation with low tidal volumes and prone positioning is the cornerstone of treatment. However, these strategies do not fully account for patient-specific physiological variability. Recent guidelines emphasize a more individualized approach to respiratory support. Key elements include limitation of driving pressure, optimized use of high-flow nasal oxygen, and application of bedside tools such as the SpO2\/FiO2 ratio and lung ultrasound. These measures improve diagnosis, monitoring, and physiological assessment at the bedside. This narrative review summarizes current evidence supporting contemporary ventilatory and non-invasive strategies in ARDS. It also examines emerging diagnostic and therapeutic approaches that integrate respiratory physiology into clinical decision-making. Finally, we discuss future directions focused on personalized, physiology-guided management to improve outcomes in patients with ARDS.<\/jats:p>","DOI":"10.3390\/medicina62020420","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T11:39:10Z","timestamp":1771846750000},"page":"420","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Advances in Imaging and Physiology-Guided Personalized Care in Acute Respiratory Distress Syndrome"],"prefix":"10.3390","volume":"62","author":[{"given":"Lucas Rodrigues","family":"Moraes","sequence":"first","affiliation":[{"name":"Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Leme","family":"Silva","sequence":"additional","affiliation":[{"name":"Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6895-6442","authenticated-orcid":false,"given":"Denise","family":"Battaglini","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16126 Genoa, Italy"},{"name":"Anesthesia and Intensive Care, IRCCS Azienda Ospedaliera Metropolitana, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1412-7136","authenticated-orcid":false,"given":"Patricia Rieken Macedo","family":"Rocco","sequence":"additional","affiliation":[{"name":"Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1164\/rccm.202303-0558WS","article-title":"A New Global Definition of Acute Respiratory Distress Syndrome","volume":"209","author":"Matthay","year":"2024","journal-title":"Am. 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