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Conclusion We need a more individualised approach of hypoxic respiratory failure and ARDS. It is questionable that the new Berlin ARDS definition was the most required change to our approach of ARDS. One could argue that our patients could be better off, if we had moved away from trying to find commonality between very different conditions as the old and new ARDS definitions do. The ‘one size fits all’ approach tried for many years has not led to substantial progress. It may be high time for a different strategy and during the mean time, it may also be wise to use physiology as a compass to avoid the obvious mistakes associated with a cookbook approach.

Making sense of the pressure of arterial oxygen to fractional inspired oxygen concentration ratio in patients with acute respiratory distress syndrome