Precision medicine in Acute Respiratory Distress Syndrome
1Department of Intensive Care Medicine, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
2NUTRIM school of Nutrition and Translational Research, Maastricht University, 6229 HX Maastricht, The Netherlands
3Department of Intensive Care Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
4Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Centers, location Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
5Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, 10330 Bangkok, Thailand
6Nuﬃeld Department of Medicine, University of Oxford, OX3 Oxford, UK
7Department of Respiratory Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
Submitted: 30 August 2021 Accepted: 14 October 2021
Online publish date: 16 November 2021
Many patients with acute respiratory failure fulfill the diagnosis of Acute Respiratory Distress Syndrome (ARDS), forming a very heterogeneous population. Clinical trials have not yielded beneficial treatment effects in ARDS, possibly caused by this heterogeneity. Dividing patients with ARDS into subgroups, each with similar characteristics, may result in improved treatment strategies as part of a precision medicine approach. In this systematic review, we summarize the subphenotypes identified so far, the current state, and future directions for precision medicine in ARDS. Multiple data-driven subphenotypes have been identified based on a wide range of variables. These subphenotypes are associated with differences in clinical outcomes, which could be used for prognostic- and predictive enrichment of future interventional studies. True treatable traits have not been identified yet, deeper phenotyping will hopefully reveal these along with mechanistic differences.
Precision medicine; Phenotypes; ARDS
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