Manuel S. Pérez-Díaz, Servicio de Urgencias adultos, Hospital Regional, Licenciado Adolfo López Mateos, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
Regina Solares-Zendejas, Departamento de Cardioneumología, Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México

Advances in the understanding of Acute Respiratory Distress Syndrome (ARDS) have led to the identification of various phenotypes, subphenotypes, and endotypes, allowing for a deeper understanding of its heterogeneity. Traditionally, ARDS has been classified into phenotypes based on clinical and pathophysiological characteristics, but recent research has identified specific subphenotypes and endotypes that reflect variations in the biological and molecular response to lung injury. The identification of these phenotypes, subphenotypes, and endotypes is achieved through advanced data analysis techniques such as genomics, proteomics, and metabolomics, which enable a detailed assessment of the underlying biological and molecular patterns. This approach not only improves the accuracy of ARDS diagnosis but also facilitates the understanding of its complexity. This review addresses the definition of the different phenotypes, subphenotypes, and endotypes of ARDS and the current description of its heterogeneity. Treatment will not be discussed in this review, as the goal is to provide a solid foundation for the classification and understanding of ARDS, highlighting recent advances and their impact on clinical practice. Research on ARDS phenotypes, subphenotypes, and endotypes is continuously evolving. By clarifying the individual characteristics of each patient, it is possible to optimize diagnostic accuracy and enhance the understanding of this serious respiratory condition.

Keywords: Acute respiratory distress syndrome. Phenotype. Subphenotype. Endotype. Mechanical ventilation.