Aerosol Therapy in Acute Respiratory Distress Syndrome: From Bench to Bedside

Acute Respiratory Distress Syndrome (ARDS) remains a major cause of morbidity and mortality in critically ill patients worldwide, despite advances in ventilatory strategies and supportive care. Pharmacological interventions that directly target the injured lung have long been of interest, yet systemic drug delivery in ARDS is often limited by poor pulmonary bioavailability and significant systemic adverse effects. In this context, aerosol therapy is a biologically plausible and clinically attractive strategy to deliver medications directly to the site of lung injury. This Research Topic, proposed for Frontiers in Medicine, aims to provide a comprehensive, state-of-the-art overview of aerosolized therapies in ARDS, integrating experimental evidence, clinical practice patterns, and emerging innovations. While aerosol drug delivery is well established in chronic airway diseases, its role in ARDS—particularly in mechanically ventilated patients—remains underexplored, heterogeneous, and controversial. Variability in aerosol devices, ventilator settings, drug formulations, patient–ventilator interactions, and disease phenotypes has contributed to inconsistent clinical outcomes and uncertainty among clinicians.The scope of this Research Topic spans the entire translational spectrum. We welcome original research, systematic reviews, meta-analyses, and high-quality narrative reviews addressing aerosolized antibiotics, bronchodilators, corticosteroids, anticoagulants, surfactant therapy, mucolytics, vasodilators, and novel biological or nanotechnology-based inhaled agents in ARDS. Particular emphasis will be placed on aerosol therapy in invasively ventilated patients, as well as in those receiving non-invasive ventilation and high-flow nasal oxygen, where drug delivery dynamics differ substantially. In addition, this Topic seeks to highlight critical knowledge gaps related to aerosol deposition in injured lungs, optimal device selection, ventilator circuit factors, dosing strategies, safety concerns (including environmental contamination and healthcare worker exposure), and the impact of ARDS subphenotypes on therapeutic response. Contributions exploring real-world practice patterns, implementation science, and guideline discrepancies across regions are especially encouraged. By bringing together basic scientists, intensivists, pulmonologists, anesthesiologists, pharmacologists, and biomedical engineers, this Research Topic aims to foster interdisciplinary dialogue and generate clinically meaningful insights. Ultimately, our goal is to clarify the current role of aerosol therapy in ARDS, identify patient populations most likely to benefit, and outline future research priorities that may translate into improved outcomes for this vulnerable population. We warmly invite authors from across the globe to contribute their expertise to this timely and clinically relevant Research Topic.We welcome submissions addressing, but not limited to, the following themes:• Pharmacology and clinical efficacy of aerosolized therapies in ARDS• Comparative effectiveness of different aerosol drug classes and formulations• Advances in aerosol device technology and optimization during mechanical ventilation• Factors influencing aerosol deposition and distribution in injured lungs• Safety concerns, environmental contamination, and healthcare worker protection• Impact of ARDS subphenotypes and patient characteristics on therapeutic outcomes• Implementation science, guideline development, and international practice variationsTopic Editor Dr. Gustavo A. Plotnikow declares the following COI - Gustavo has received funding for teaching programs from Medtronic Argentina, ICU Medical LATAM, and Vapotherm Inc. USA. He is also affiliated with the British Hospital of Buenos Aires, Argentina, for the CAVIARDS trial (ClinicalTrials.gov: NCT03963622), which is supported by Unity Health Toronto, Toronto, Canada. Topic editors: Sanjay Singhal, Dr. Antonio M. Esquinas PhD, FCCP, FNIV, Manjush Karthika, Gustavo A. Plotnikow Source: https://www.frontiersin.org/research-topics/77726/aerosol-therapy-in-acute-respiratory-distress-syndrome-from-bench-to-bedside