CHEST Guidelines-In-ARDS,-Heterogeneity =-Opportunity

In-ARDS,-Heterogeneity =-Opportunity_chest

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The article discusses the complexity and heterogeneity of Acute Respiratory Distress Syndrome (ARDS), originally identified in 1967. ARDS presents consistent respiratory distress symptoms, but the underlying causes can vary, including conditions like trauma, pneumonia, and pancreatitis. Historically, there has been a debate between "lumpers" who treat all ARDS cases similarly and "splitters" who advocate for differentiation into subgroups. Early ARDS research struggled due to inconsistencies caused by these differing approaches and the complexity observed when translating animal model findings to human clinical settings.<br /><br />There is growing recognition of the heterogeneity in ARDS, not only in terms of causes such as sepsis and trauma but also in how different factors like age, sex, ethnicity, and clinical care practices affect it. This has led to evolving definitions and greater understanding of the syndrome's pathogenesis. Large, well-characterized cohorts have been developed to capture these variations, leading to the identification of new phenotypes and biomarkers.<br /><br />The article highlights a study by Luo et al., using data from the VALID study, which demonstrated that while mortality rates did not differ significantly between direct and indirect ARDS, associated clinical characteristics varied. Age, lung injury score, and organ failure were linked to increased mortality in direct ARDS, whereas indirect ARDS mortality correlated more with organ failure.<br /><br />Luo et al.'s study limitations include the exclusion of common risk factors like trauma and the use of older ARDS definitions. Despite these limitations, the findings emphasize the importance of recognizing distinct patient populations within ARDS to advance diagnostics, develop targeted therapies, and personalize patient care. Such distinctions are crucial for progress in understanding and treating ARDS effectively.

Keywords

ARDS

heterogeneity

trauma

pneumonia

phenotypes

biomarkers

VALID study

mortality

personalized care

pathogenesis