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Lung Injury and Acute Respiratory Distress Syndrome: New Insights into...
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Lung Injury and Acute Respiratory Distress Syndrome: New Insights into Mechanisms and Emerging Therapies

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: 31 October 2026 | Viewed by 1363

Special Issue Editors

Dr. Denise Battaglini

E-Mail Website
Guest Editor
1. Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
2. Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Interests: mechanical ventilation; ARDS; respiratory mechanics; respiratory physiology; ventilator-induced lung injury; intensive care medicine; critical care medicine; airway management; tracheostomy; anesthesia; anesthesiology; sepsis
Special Issues, Collections and Topics in MDPI journals
Dr. Raffaele Merola

E-Mail Website
Guest Editor Assistant
Anesthesia and Intensive Care Medicine, Department of Critical Care, AORN Ospedali Dei Colli, 80131 Naples, Italy
Interests: mechanical ventilation; ARDS; respiratory mechanics; respiratory physiology; ventilator-induced lung injury; intensive care medicine; critical care medicine; airway management; tracheostomy; anesthesia; anesthesiology; sepsis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in critically ill patients, and there are still limited effective treatment options, despite decades of research. Through this Special Issue, “Lung Injury and Acute Respiratory Distress Syndrome: New Insights into Mechanisms and Emerging Therapies”, we aim to advance our understanding of the pathophysiology behind ARDS, as well as emerging therapeutic options. We welcome papers on topics ranging from the molecular and cellular mechanisms of inflammation underlying this syndrome to emerging pharmacological and supportive therapies. By highlighting recent advances and identifying key knowledge gaps, this Special Issue will support the development of more effective and targeted approaches to preventing and treating ARDS in diverse patient populations.

Dr. Denise Battaglini
Guest Editor

Dr. Raffaele Merola
Guest Editor Assistant

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. Medicina is an international peer-reviewed open access monthly 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 2200 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

  • acute respiratory distress syndrome
  • lung injury
  • mechanical power
  • mechanical ventilation
  • transpulmonary pressure
  • ventilator-induced lung injury

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Published Papers (1 paper)

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Review

18 pages, 1501 KB  
Review
Extracorporeal Carbon Dioxide Removal in Acute Respiratory Distress Syndrome: Physiologic Rationale and Phenotype-Based Perspectives
by Raffaele Merola, Denise Battaglini and Silvia De Rosa
Medicina 2026, 62(2), 236; https://doi.org/10.3390/medicina62020236 - 23 Jan 2026
Viewed by 952
Abstract
Acute respiratory distress syndrome (ARDS) is a major cause of morbidity and mortality despite decades of progress in ventilatory support. Mechanical ventilation, while essential for oxygenation, may exacerbate lung injury through excessive mechanical power delivery, even when using lung-protective strategies. Extracorporeal carbon dioxide [...] Read more.
Acute respiratory distress syndrome (ARDS) is a major cause of morbidity and mortality despite decades of progress in ventilatory support. Mechanical ventilation, while essential for oxygenation, may exacerbate lung injury through excessive mechanical power delivery, even when using lung-protective strategies. Extracorporeal carbon dioxide removal (ECCO2R) was conceived to enable “ultra-protective” ventilation, allowing for further reductions in tidal volume and respiratory rate by selectively removing CO2 at low extracorporeal blood flows, typically between 0.3 and 1.0 L/min. This physiological decoupling of ventilation and gas exchange aims to mitigate ventilator-induced lung injury (VILI) while maintaining adequate acid–base homeostasis. Although early physiological studies demonstrated feasibility, large, randomized trials have failed to show a survival benefit and have raised concerns about bleeding and technical complications. Recent evidence suggests that these neutral outcomes may stem from the biological and physiological heterogeneity of ARDS rather than from inefficacy of the intervention itself. Patients with high driving pressures, poor compliance, or hyperinflammatory phenotypes may derive greater benefit from ECCO2R-mediated mechanical unloading. Ongoing technological improvements, including circuit miniaturization, enhanced biocompatibility, and integration with renal replacement therapy, have improved safety and feasibility, yet the procedure remains complex and resource-intensive. Future research should focus on phenotype-enriched trials and the integration of ECCO2R into precision ventilation frameworks. Ultimately, ECCO2R should be regarded not as a universal therapy for ARDS but as a targeted physiological tool for selected patients in experienced centers. Full article
(This article belongs to the Special Issue Lung Injury and Acute Respiratory Distress Syndrome: New Insights into Mechanisms and Emerging Therapies)
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