Abstract: Acute respiratory distress syndrome (ARDS) is a common critical illness in clinical practice, with a high mortality rate. Given the limited traditional treatment options for ARDS and the high heterogeneity among patients, most clinical trials have failed to yield positive results. Precision medicine aims to address this challenge by refining ARDS subphenotypes and tailoring therapeutic strategies to distinct patient subgroups, thereby improving clinical outcomes and reducing mortality. This consensus statement synthesizes clinical researches and expert recommendations to propose actionable frameworks for precision phenotyping and targeted treatment of ARDS. The goal is to provide clinicians with evidence-based guidance and accelerate the advancement of precision diagnosis and management in ARDS.