Acute hypoxemic respiratory failure (AHRF) is one of the leading causes A for admission to the ICU. Acute respiratory failure (ARF) is defined as the inability of the respiratory system to meet the oxygenation and ventilation requirements of the patient.

Respiratory support for oxygenation, for example, with high-flow nasal cannula (HFNC), and of ventilation, with mechanical ventilation is required to sustain effective gas exchange while treatment for the underlying condition is initiated. Critically ill patients with AHRF frequently fulfill the criteria for acute respiratory distress syndrome (ARDS).

Patients with ARDS exhibit exudative pulmonary edema due to increased permeability of the alveolar-capillary membrane due to injury.

The pathophysiology of ARDS involves a local or systemic inflammatory response, endothelial dysfunction, and epithelial injury.

These processes are not captured in the clinical definition of the syndrome, and there is poor agreement between the clinical criteria and histopathological evaluation postmortem.

In recent years, the clinical criteria for ARDS have been broadened, and the recently published global definition allows patients supported with HFNC alone to be classified as having ARDS.

In effect, this will result in an even larger proportion of patients with AHRF who fulfill the criteria of ARDS. Simultaneous with the trend to broaden the diagnostic criteria for ARDS, there has also been a redirected focus on the further development of precision medicine strategies for ARF in general and ARDS in particular.

This review aims to answer three questions related to precision medicine in ARF: 1) why do we need it; 2) what has been done so far, and 3) what is the agenda going forward?

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