Respiratory medicine in the ICU 2026: From physiology to precision care
- 1National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- 2Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
Abstract
This annual review summarizes major advances in respiratory medicine in the intensive care unit (ICU) published in 2025, focusing on high-impact clinical and translational studies most likely to influence current practice and future research. Across the field, 2025 strengthened the evidence base for key physiological concepts while more clearly defining where physiological strategies translate into clinical benefit and where broadly applied interventions remain insufficient, reflecting an increasing shift toward precision-based respiratory care. Precision medicine advanced through open-source inflammatory acute respiratory distress syndrome (ARDS) subphenotype classifiers and trajectory-based physiological phenotypes that outperform static definitions and support time-dependent treatment strategies. Evidence for non-invasive respiratory support expanded in obesity, immunocompromised patients, and procedure-related hypoxemia, emphasizing that implementation factors such as duration, staffing, and positive end-expiratory pressure (PEEP) strategy strongly influence success. Prospective multicenter cohorts reinforced the prognostic relevance of driving pressure (DP) and mechanical power, whereas randomized trials indicated that DP-guided PEEP titration and advanced ventilator modes do not reliably improve patient-centered outcomes when broadly applied under lung-protective targets. A major 2025 development was the operationalization of spontaneous breathing risk, and bedside indices of inspiratory efforts (Pocc and P0.1) were linked to pendelluft and outcomes, with oxygenation severity modifying harm versus benefit, supporting an effort-guided framework for preventing patient self-inflicted lung injury. In ARDS, prolonged inhaled volatile sedation failed to improve outcomes and was associated with possible harm compared with intravenous sedation. The largest 2025 oxygen trial showed no mortality benefit for broadly conservative targets, while subgroup analyses suggested heterogeneity of treatment effect. Electrical impedance tomography advanced toward bedside stratification and individualized titration, including emerging three-dimensional approaches. Finally, 2025 strengthened long-term outcome data for extracorporeal membrane oxygenation (ECMO) and ICU survivorship, reinforcing recovery as a core component of respiratory critical care.
Related
- Acute respiratory distress syndrome subphenotypes: the translational path from pathobiology to precision medicine
- The maturation of precision medicine into pragmatic, patient-centered care: A commentary on the 2026 EHA CLL Guidelines.
- Precision medicine for older adults with multimorbidity through a whole-person and palliative care approach
- Integrating cure and care in Alzheimer's disease: a systems perspective for precision medicine.
- Case Report: Multimodal treatment of pediatric H3G34-mutant diffuse hemispheric glioma: a safety and feasibility case report combining precision medicine and tumor treating fields with conventional care
BibTeX
@article{xia2026respiratory,
title = {{Respiratory medicine in the ICU 2026: From physiology to precision care}},
author = {Jingen Xia and Zhangli Wu and Haibo Zhang},
journal = {Journal of intensive medicine},
year = {2026},
month = may,
doi = {10.1016/j.jointm.2026.04.002},
url = {https://europepmc.org/article/PMC/PMC13728407},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Respiratory medicine in the ICU 2026: From physiology to precision care
AU - Jingen Xia
AU - Zhangli Wu
AU - Haibo Zhang
PY - 2026
DA - 2026/05/26
JO - Journal of intensive medicine
DO - 10.1016/j.jointm.2026.04.002
UR - https://europepmc.org/article/PMC/PMC13728407
AB - This annual review summarizes major advances in respiratory medicine in the intensive care unit (ICU) published in 2025, focusing on high-impact clinical and translational studies most likely to influence current practice and future research. Across the field, 2025 strengthened the evidence base for key physiological concepts while more clearly defining where physiological strategies translate into clinical benefit and where broadly applied interventions remain insufficient, reflecting an increasing shift toward precision-based respiratory care. Precision medicine advanced through open-source inflammatory acute respiratory distress syndrome (ARDS) subphenotype classifiers and trajectory-based physiological phenotypes that outperform static definitions and support time-dependent treatment strategies. Evidence for non-invasive respiratory support expanded in obesity, immunocompromised patients, and procedure-related hypoxemia, emphasizing that implementation factors such as duration, staffing, and positive end-expiratory pressure (PEEP) strategy strongly influence success. Prospective multicenter cohorts reinforced the prognostic relevance of driving pressure (DP) and mechanical power, whereas randomized trials indicated that DP-guided PEEP titration and advanced ventilator modes do not reliably improve patient-centered outcomes when broadly applied under lung-protective targets. A major 2025 development was the operationalization of spontaneous breathing risk, and bedside indices of inspiratory efforts (Pocc and P0.1) were linked to pendelluft and outcomes, with oxygenation severity modifying harm versus benefit, supporting an effort-guided framework for preventing patient self-inflicted lung injury. In ARDS, prolonged inhaled volatile sedation failed to improve outcomes and was associated with possible harm compared with intravenous sedation. The largest 2025 oxygen trial showed no mortality benefit for broadly conservative targets, while subgroup analyses suggested heterogeneity of treatment effect. Electrical impedance tomography advanced toward bedside stratification and individualized titration, including emerging three-dimensional approaches. Finally, 2025 strengthened long-term outcome data for extracorporeal membrane oxygenation (ECMO) and ICU survivorship, reinforcing recovery as a core component of respiratory critical care.
SN - 2097-0250
SN - 2667-100X
ER -