Since the concept of acute respiratory distress syndrome (ARDS) was first proposed by Ashbaugh in 1967 [1], it has been refined several times for better reflect the phenotype in recent decades. The Berlin definition defines ARDS as an acute progressive condition characterized by refractory hypoxemia and bilateral pulmonary infiltrates, which is related to excessive uncontrolled inflammation. The new definition of ARDS was put forward in 2024 [2], which recommended inclusion of high flow oxygen, use of pulse oximetry, ultrasound as imaging method, and absence of respiratory support in resources limited areas in clinical diagnosis of ARDS according to the Berlin definition.