Table 3.

Potential Strategies for Personalized Management of ARDS

Therapy	Personalized Approach
Tidal volume	Scale to “ARDS baby lung” size Airway driving pressure Tidal stress (tidal change in transpulmonary pressure) Functional residual capacity Inspiratory capacity
Positive end-expiratory pressure	Titrate to patient-specific respiratory mechanics Highest respiratory system compliance Esophageal pressure-guided titration Stress index ExPress PEEP Pressure-volume curve lower inflection point Electrical impedance tomography-measured recruitment
Neuromuscular blockade	Target to therapeutic mechanism for duration at risk Breath stacking dyssynchrony prevention (active inspiration with double- or reverse-triggering) Atelectrauma prevention (active expiration)
Prone positioning	Institute when mechanism of benefit likely Increase in lung mechanical homogeneity or recruitment Enhanced tracheobronchial secretion drainage
Extracorporeal support	Graded introduction when safe mechanical ventilation parameters yield insufficient gas exchange ECCO2R when tidal volume reduction required to prevent further lung injury is insufficient for CO2 excretion VV-ECMO for refractory hypoxemia
Pharmacotherapy	Inhibit biotrauma propagation Immunomodulators for proinflammatory subgroup Target downstream mediators of extrapulmonary organ injury (e.g. angiopoietin-2) Augment adaptive lung repair mechanisms