[Annual advances in clinical research on mechanical ventilation in management of respiratory failure 2025].

This review summarizes key advances in mechanical ventilation for respiratory failure reported in 2025. In patients with acute respiratory distress syndrome receiving invasive ventilation, the emphasis has shifted from standardized protocols to individualized lung-protective strategies, with positive end-expiratory pressure (PEEP) titration increasingly guided by respiratory mechanics and multimodal physiological parameters. Airway pressure release ventilation has emerged as a promising tool for improving dorsal ventilation-perfusion matching, while prone positioning assessment has moved toward dynamic response evaluation. Conversely, studies have indicated that extrapolating lung-protective ventilation to patients with acute brain injury has yielded no clear benefit and has been associated with risks of neurological deterioration. Weaning management has focused on personalized spontaneous breathing trials and early identification of difficult weaning population to shorten ventilation duration. Regarding non-invasive ventilation (NIV), recent studies employing refined patient stratification have suggested that higher PEEP for hypoxemic respiratory failure and higher pressure support for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) may mitigate intubation risks. For patients with chronic respiratory failure, long-term domiciliary NIV have focused on optimization of interface selection and enhancement of patient adherence. In summary, these findings highlight that mechanical ventilation is progressing toward more precise and individualized strategies to improve patient-centered clinical outcomes.