Towards a biological definition of ARDS: are treatable traits the solution?

The pathophysiology of acute respiratory distress syndrome (ARDS) includes the accumulation of protein-rich pulmonary edema in the air spaces and interstitial areas of the lung, variable degrees of epithelial injury, variable degrees of endothelial barrier disruption, transmigration of leukocytes, a...

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Published inIntensive care medicine experimental Vol. 10; no. 1; pp. 8 - 14
Main Authors Bos, Lieuwe D. J., Laffey, John G., Ware, Lorraine B., Heijnen, Nanon F. L., Sinha, Pratik, Patel, Brijesh, Jabaudon, Matthieu, Bastarache, Julie A., McAuley, Daniel F., Summers, Charlotte, Calfee, Carolyn S., Shankar-Hari, Manu
Format Journal Article
LanguageEnglish
Published Cham Springer International Publishing 11.03.2022
Springer Nature B.V
SpringerOpen
Subjects
ARDS
Biomarker
Biomarkers
Critical Care Medicine
Definition
Diagnosis
Edema
Genotype & phenotype
Intensive
Intensive care
Medical diagnosis
Medicine
Medicine & Public Health
Pathophysiology
Phenotype
Respiratory distress syndrome
Reviews
Definition
Biomarker
Phenotype
Diagnosis
Pathophysiology
ARDS
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ISSN2197-425X
2197-425X
DOI10.1186/s40635-022-00435-w

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Summary:The pathophysiology of acute respiratory distress syndrome (ARDS) includes the accumulation of protein-rich pulmonary edema in the air spaces and interstitial areas of the lung, variable degrees of epithelial injury, variable degrees of endothelial barrier disruption, transmigration of leukocytes, alongside impaired fluid and ion clearance. These pathophysiological features are different between patients contributing to substantial biological heterogeneity. In this context, it is perhaps unsurprising that a wide range of pharmacological interventions targeting these pathophysiological processes have failed to improve patient outcomes. In this manuscript, our goal is to provide a narrative summary of the potential methods to capture the underlying biological heterogeneity of ARDS and discuss how this information could inform future ARDS redefinitions. We discuss what biological tests are available to identify patients with any of the following predominant biological patterns: (1) epithelial and/or endothelial injury, (2) protein rich pulmonary edema and (3) systemic or within lung inflammatory responses.
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ISSN:2197-425X
2197-425X
DOI:10.1186/s40635-022-00435-w