CHEST Guidelines-Embracing-the-Heterogeneity-of-ARDS

Embracing-the-Heterogeneity-of-ARDS_chest
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The article "Embracing the Heterogeneity of ARDS" by Jason H. Maley and B. Taylor Thompson examines the complex nature of Acute Respiratory Distress Syndrome (ARDS) and its varying manifestations among patients. Over the past 52 years, numerous clinical trials and epidemiological studies have highlighted the significant diversity in the presentation, progression, and outcomes of ARDS, even among patients with similar initial triggers, such as viral infections. This heterogeneity poses challenges for diagnosis and treatment.<br /><br />Key findings from studies like the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) underscore this diversity. About 17% of ARDS patients improved significantly within 24 hours, indicating variability in disease severity. Additionally, ARDS is not always associated with diffuse alveolar damage (DAD), the historical pathological hallmark, further complicating diagnoses.<br /><br />Schenck and colleagues introduce the term "rapidly improving ARDS" (riARDS), describing patients who quickly attain a PaO2:FIO2 ratio ≥300 mm Hg and unassisted breathing shortly after study enrollment. This subset had lower mortality rates compared to others with longer-lasting ARDS. Their research draws attention to the need for correctly identifying and understanding these patients for improving clinical trial outcomes.<br /><br />The article questions whether riARDS patients truly fit the ARDS profile and how their inclusion in trials might skew results. It highlights the potential issues of prognostic and predictive enrichment in ARDS research, advocating for a focus beyond mere disease severity towards identifying treatment-responsive subtypes.<br /><br />Ultimately, the authors urge that future ARDS research emphasize early identification and targeted therapies, potentially utilizing biomarkers to distinguish between hyper- and hypo-inflammatory subphenotypes, which can respond differently to various treatment strategies. This approach will help develop effective therapies benefiting all patients across the ARDS severity spectrum.
Keywords
ARDS
heterogeneity
clinical trials
LUNG SAFE
riARDS
diagnosis
treatment
biomarkers
subphenotypes
therapies