A Research Agenda for Precision Medicine in Sepsis and Acute Respiratory Distress Syndrome: An Official American Thoracic Society Research Statement

Acute respiratory distress syndrome (ARDS) is a devastating critical illness that can be triggered by a wide range of insults and remains associated with a high mortality of around 40%. The search for targeted treatment for ARDS has been disappointing, possibly due to the enormous heterogeneity within the syndrome. In this perspective from the European Respiratory Society research seminar on “Precision medicine in ARDS”, we will summarise the current evidence for heterogeneity, explore the evidence in favour of precision medicine and provide a roadmap for further research in ARDS. There is evident variation in the presentation of ARDS on three distinct levels: 1) aetiological; 2) physiological and 3) biological, which leads us to the conclusion that there is no typical ARDS. The lack of a common presentation implies that intervention studies in patients with ARDS need to be phenotype aware and apply a precision medicine approach in order to avoid the lack of success in therapeutic trials that we faced in recent decades. Deeper phenotyping and integrative analysis of the sources of variation might result in identification of additional treatable traits that represent specific pathobiological mechanisms, or so-called endotypes.

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Reply to Morales-Quinteros et al.: Precision Medicine for Extracorporeal CO2 Removal for Acute Respiratory Distress Syndrome: CO2 Physiological Considerations

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.201711-2226le ◽

2018 ◽

Vol 197 (8) ◽

pp. 1091-1092

Author(s):

Ewan C. Goligher ◽

Marcelo B. P. Amato ◽

Arthur S. Slutsky

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Precision Medicine ◽

Distress Syndrome ◽

Co2 Removal ◽

Extracorporeal Co2 Removal

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Erratum: An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.19511erratum ◽

2017 ◽

Vol 195 (11) ◽

pp. 1540-1540 ◽

Cited By ~ 2

Keyword(s):

Mechanical Ventilation ◽

Critical Care ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Clinical Practice ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Clinical Practice Guideline ◽

Distress Syndrome ◽

American Thoracic Society

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Acute respiratory distress syndrome phenotyping and latent class analysis, first steps toward precision medicine in critical care illness?

Journal of Thoracic Disease ◽

10.21037/jtd.2019.01.13 ◽

2019 ◽

Vol 11 (S3) ◽

pp. S303-S306 ◽

Cited By ~ 1

Author(s):

Christophe Guervilly ◽

Gabriel Parzy ◽

Laurent Papazian

Keyword(s):

Critical Care ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Latent Class Analysis ◽

Precision Medicine ◽

Latent Class ◽

Distress Syndrome ◽

Class Analysis

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Mechanical Ventilation in Adults with Acute Respiratory Distress Syndrome An Official Clinical Guideline of American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine

Russian Pulmonology ◽

10.18093/0869-0189-2018-28-4-399-410 ◽

2018 ◽

Vol 28 (4) ◽

pp. 399-410

Author(s):

Editorial Article

Keyword(s):

Mechanical Ventilation ◽

Critical Care ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

European Society ◽

Distress Syndrome ◽

American Thoracic Society ◽

Adult Patients

Adopted from: Fan E., Del Sorbo L., Goligher E.C., Hodgson C.L., Munshi L., Walkey A.J., Adhikari N.K.J., Amato M.B.P., Branson R., Brower R.G., Ferguson N.D., Gajic O., Gattinoni L., Hess D., Mancebo J., Meade M.O., McAuley D.F., Pesenti A., Ranieri V.M., Rubenfeld G.D., Rubin E., Seckel M., Slutsky A.S., Talmor D., Thompson B. T., Wunsch H., Uleryk E., Brozek J., Brochard L.J. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am. J. Respir. Crit. Care Med. 2017; 195 (9): 1253–1263. DOI: 10.1164/rccm.201703-0548STThe aim of this guideline is to provide clinical recommendation on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS).Methods. This guideline is based on systematic review and metaanalysis of available literature on the use of mechanical ventilation in adult patients with ARDS.Results. All patients with ARDS should be mechanically ventilated with the use of lower tidal volumes (4–8 ml/kg predicted bodyweight) and lower inspiratory pressures (plateau pressure, 30 cm H2O). In severe ARDS, the prone positioning for more than 12 h/d is strongly recommended. In patients with moderate to severe ARDS, routine use of high-frequency oscillatory ventilation is not recommended; a conditional recommendation has been developed for the use of higher positive end-expiratory pressure and recruitment maneuvers. CuОР – ently, there is not enough evidence for the use of extracorporeal membrane oxygenation in patients with severe ARDS.Conclusions. Practical recommendations on selected methods to coОР – ect ventilation disturbances in adult patients with ARDS have been developed. Clinicians involved in the management of patients with ARDS should use personalized approach to the treatment of these patients.

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