This issue of Chest Medicine focuses on respiratory distress syndrome and covers the following topics: epidemiology and definition of ARDS and early lung injury, environmental risk of ARDS, and clinical and biological heterogeneity of ARDS: direct lung injury. Lung damage, Obesity and nutrition, Important immunomodulators in ARDS?, Beyond SNPs – genetics, Genomics and other omics aspects of ARDS, Treatment of patients with ARDS, Immunocompromised patients with ARDS: invasive diagnostic strategies Development of clinical and role trials, Treatment of ARDS beyond volume reduction in ARDS, ventilation in patients with ARDS, positioning in ARDS and much more!