{"id":411,"date":"2025-01-02T09:15:20","date_gmt":"2025-01-02T09:15:20","guid":{"rendered":"https:\/\/perfusfind.com\/ic\/?p=411"},"modified":"2025-01-02T09:16:15","modified_gmt":"2025-01-02T09:16:15","slug":"gattinonis-legacy-personalizing-ards-management-through-physiology","status":"publish","type":"post","link":"https:\/\/perfusfind.com\/ic\/index.php\/2025\/01\/02\/gattinonis-legacy-personalizing-ards-management-through-physiology\/","title":{"rendered":"Gattinoni\u2019s Legacy: Personalizing ARDS Management Through Physiology"},"content":{"rendered":"
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While writing this editorial, we learned that Professor Luciano Gattinoni\u2014a giant in our field\u2014had passed away. \u201cGiant\u201d seems an inadequate descriptor for a physician-scientist whose profound insights have fundamentally reshaped our understanding of critical care in general, and of acute respiratory distress syndrome (ARDS) in particular. His enduring legacy will continue to impact researchers, clinicians, and\u2014most importantly\u2014patients worldwide. It is our privilege to offer comment on some of his final contributions to the field of ARDS.<\/p>\n<\/div>\n

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Since Ashbaugh and colleagues\u2019 first description of ARDS in 1967 [1<\/a>], efforts have been made to classify ARDS by disease severity to guide prognosis and treatment [2<\/a>,3<\/a>,4<\/a>,5<\/a>]. Oxygenation impairment, as defined by PaO2<\/sub>:FiO2<\/sub>\u00a0(P:F) or SaO2<\/sub>:FiO2<\/sub>\u00a0(S:F) ratios, is the primary basis for classifying severity in the Berlin Definition [4<\/a>] and in the new Global Definition of ARDS [5<\/a>]. However, other approaches for stratifying ARDS are emerging based on observations of differential risk and differential treatment response, including biological subphenotyping [6<\/a>] and respiratory mechanics [7<\/a>].<\/p>\n<\/div>\n

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In this issue of Intensive Care Medicine, Catozzi et al. [8<\/a>] report the results of a study in which they suggest that hypoxemia may not be the most relevant parameter to guide lung-protective ventilation strategies in ARDS. They conducted a retrospective analysis of computed tomography scans, respiratory mechanics, and gas exchange in 228 ARDS patients with P:F ratio\u2009<\u2009200\u00a0mmHg. They found no association between hypoxemia and driving pressure (\u0394P) or mechanical power and concluded that respiratory mechanics and ventilatory ratio (a surrogate for dead space), rather than severity of hypoxemia, may be more relevant markers of risk for ventilator-induced lung injury. On this basis, they suggested that intensification of therapies for ARDS based on the severity of hypoxemia may be misguided.<\/p>\n

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