Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterised as acute hypoxaemic respiratory failure due to non-cardiogenic pulmonary oedema.1 Excessive activation of the immune system causing innate immune cell recruitment and the overproduction of cytokines is a driving cause of ARDS, damaging the alveolar-capillary barrier and impairing gas exchange.2 In the Berlin definition, ARDS is classified into three categories based on the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (P/F) at the positive end-expiratory pressure of ≥5 cm H2O.3 ARDS is classified as mild, moderate or severe, defined by 300≥P/F>200 mm Hg, 200≥P/F>100 mm Hg and P/F ≤100 mm Hg, respectively.3 ARDS is a global health burden. While its mortality has declined due to an improvement of medical care including the institution of lung protective ventilation and advanced monitoring,4 the mortality remains very high….
