Lung imaging in patients with acute respiratory distress syndrome: from an understanding of pathophysiology to bedside monitoring.

Over the last 25 years, lung imaging has changed our understanding of acute respiratory distress syndrome. Alveolar recruitment, hyperinflation, and positive end-expiratory pressure-induced changes in lung aeration have become evaluable using CT, PET, and ultrasonography. The data have revealed that patients differ, in that the required ventilator settings vary in those with the same syndrome. At the bedside, however, care physicians remain blinded. Bedside tools allowing monitoring of mechanical ventilation, and testing of ventilator settings, are urgently required. The aim of the present review is to consider how lung imaging has facilitated the evolution of knowledge of this syndrome, and to place such knowledge in a clinical perspective.