![]() Innovations in bedside imaging technologies such as electrical impedance tomography readily allow clinicians to determine the regional distributions of V and Q, as well as the adequacy of their matching, providing new insights into the phenotyping, prognostication, and clinical management of patients with ARDS. ![]() Beyond its impact on gas exchange, V/ Q mismatch is a predictor of adverse outcomes in patients with ARDS more recently, its role in ventilation-induced lung injury and worsening lung edema has been described. ![]() The perfusion of collapsed or consolidated lung units gives rise to intrapulmonary shunting and arterial hypoxemia, whereas the ventilation of non-perfused lung zones increases physiological dead-space, which potentially necessitates increased ventilation to avoid hypercapnia. In patients with ARDS, disturbances in the physiological matching of alveolar ventilation (V) and pulmonary perfusion (Q) ( V/ Q mismatch) are a hallmark derangement. It is being increasingly demonstrated that the improvement of outcomes requires a tailored, individualized approach to therapy, guided by a detailed understanding of each patient’s pathophysiology. Acute respiratory distress syndrome (ARDS) remains an important clinical challenge with a mortality rate of 35–45%.
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