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Personalized Treatments for Patients with Acute Lung Injury
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Personalized Treatments for Patients with Acute Lung Injury

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: 20 September 2026 | Viewed by 1725

Special Issue Editor

Prof. Gary F. Nieman

E-Mail Website
Guest Editor
Department of Surgery, Upstate Medical University, Syracuse, NY 13210, USA
Interests: critical care medicine; mechanical ventilation; pulmonary edema; pulmonary surfactants; ventilator-induced lung injury (VILI); ARDS; pulmonary physiology; sepsis

Special Issue Information

Dear Colleagues,

Acute respiratory distress syndrome (ARDS) was first identified in 1967, but it remains a serious medical problem with high mortality rates. Treatment mainly involves supportive measures, primarily mechanical ventilation; however, if not set correctly, it can cause secondary ventilator-induced lung injury (VILI), which can significantly increase the risk of death. In 2000, the Acute Respiratory Distress Syndrome Network (ARDSnet) reported the results of a randomized controlled trial (RCT) showing that using a low tidal volume (VT = 6 cc/kg) and a plateau airway pressure (Pplat = 30 cmH2O) significantly reduced ARDS-related mortality. Despite the ARDSnet protective-ventilation approach, mortality remains high, and the one-size-fits-all method has been widely criticized. In this Special Issue, we discuss methods for personalizing protective ventilation strategies to improve outcomes. Additionally, a holistic and personalized approach to treating patients with ARDS needs to be identified. In combination with an optimal lung-protective ventilation strategy, personalized guidance based on the patient’s pathophysiology should be incorporated into the treatment regimen. These treatments include, but are not limited to, fluid and vasopressor resuscitation, pharmacotherapy, exosomes, mesenchymal stem cells, nano-systems to enhance drug delivery, and biomarkers. All of these treatments can be further personalized by analysis of the patient’s phenotype. Computational modeling of any therapy may lead to improved personalization. It is hoped that one or more of these innovative, personalized treatment strategies, alone and in combination with others, will trigger a paradigm shift, substantially reducing ARDS-related morbidity and mortality.

Prof. Gary F. Nieman
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • personalized
  • acute lung injury
  • acute respiratory distress syndrome (ARDS)
  • ventilator-induced lung injury (VILI)
  • pharmacotherapy
  • fluid resuscitation
  • phenotypes
  • mesenchymal stem cells
  • nano-systems
  • exosomes
  • biomarkers
  • computational models

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Published Papers (1 paper)

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Review

22 pages, 2330 KB  
Review
Beyond One-Size-Fits-All: Precision Mechanical Ventilation in ARDS
by Saif Azzam, Karis Khattab, Sarah Al Sharie, Lou’i Al-Husinat, Pedro L. Silva, Denise Battaglini, Marcus J Schultz and Patricia R M Rocco
J. Clin. Med. 2026, 15(5), 2058; https://doi.org/10.3390/jcm15052058 - 8 Mar 2026
Viewed by 1496
Abstract
Acute respiratory distress syndrome (ARDS) has traditionally been managed with population-based, protocolized mechanical ventilation strategies designed to limit ventilator-induced lung injury. While these approaches have improved outcomes, they fail to account for the pronounced biological, mechanical, radiological, and temporal heterogeneity that characterizes ARDS. [...] Read more.
Acute respiratory distress syndrome (ARDS) has traditionally been managed with population-based, protocolized mechanical ventilation strategies designed to limit ventilator-induced lung injury. While these approaches have improved outcomes, they fail to account for the pronounced biological, mechanical, radiological, and temporal heterogeneity that characterizes ARDS. Accumulating evidence shows that patients differ markedly in functional lung size, recruitability, chest wall mechanics, inflammatory burden, and tolerance to ventilatory stress, making uniform ventilatory targets physiologically imprecise and, at times, harmful. This narrative review examines the evolution from conventional lung-protective ventilation toward a precision-based paradigm that aligns ventilatory support with individual patient physiology. We conceptualize ARDS not as a static syndrome but as a dynamic spectrum, viewing the injured lung as a heterogeneous mechanical system susceptible to regionally amplified stress and strain. Within this framework, we discuss key principles underlying precision ventilation, including functional lung size (the “baby lung”), driving pressure, mechanical power, patient–ventilator interaction, spontaneous breathing-associated injury, and the time-dependent evolution of lung mechanics. We synthesize current evidence supporting mechanical, biological, and radiological subphenotyping as complementary strategies to individualize ventilatory management, while critically appraising their current limitations. This review also evaluates bedside tools that may operationalize precision ventilation in clinical practice, including esophageal pressure monitoring, lung ultrasound, and electrical impedance tomography, and examines the role of artificial intelligence as a clinician-directed decision-support aid rather than a prescriptive substitute for physiological reasoning. Implications for clinical trial design, ethical considerations, and future directions toward predictive and adaptive ventilation strategies are also addressed. Precision mechanical ventilation represents a shift from rigid thresholds toward proportional, physiology-guided intervention across the disease trajectory. By integrating evolving lung mechanics, ventilatory load, and patient effort over time, this approach provides a coherent framework for safer and more effective mechanical ventilation in ARDS while preserving the core principles of lung protection. Full article
(This article belongs to the Special Issue Personalized Treatments for Patients with Acute Lung Injury)
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