ARDS Subphenotypes as a Guide to Therapy and Enrollment into Therapeutic Trials: Not So Fast

Area of Science:

• Critical Care Medicine
• Pulmonology
• Translational Research

Background:

• Acute respiratory distress syndrome (ARDS) is a complex critical illness with significant heterogeneity.
• Understanding ARDS subphenotypes is crucial for personalized treatment strategies and clinical trial design.
• Biomarkers are needed to guide precise ARDS management and improve patient outcomes.

Purpose of the Study:

• To examine the complexities in identifying distinct ARDS subphenotypes.
• To evaluate the biological plausibility and clinical utility of current subphenotype definitions.
• To discuss factors influencing ARDS heterogeneity and the search for treatable traits.

Main Methods:

• Review of current literature on ARDS subphenotyping.
• Analysis of factors contributing to clinical heterogeneity in ARDS.
• Evaluation of the evidence supporting targeted treatments for ARDS subphenotypes.

Main Results:

• ARDS heterogeneity is dynamic and influenced by multiple factors beyond lung pathophysiology.
• Current subphenotype definitions lack strong biological grounding.
• There is insufficient evidence to support the clinical use of current ARDS subphenotypes.

Conclusions:

• The search for reliable ARDS subphenotypes and treatable traits is complicated by dynamic heterogeneity.
• Current subphenotype definitions are not yet clinically warranted due to lack of biological plausibility and proven treatment efficacy.
• Further research is needed to develop biologically plausible and clinically useful ARDS subphenotypes.