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

Research output: Contribution to journalReview articlepeer-review

Lieuwe D.J. Bos, John G. Laffey, Lorraine B. Ware, Nanon F.L. Heijnen, Pratik Sinha, Brijesh Patel, Matthieu Jabaudon, Julie A. Bastarache, Daniel F. McAuley, Charlotte Summers, Carolyn S. Calfee, Manu Shankar-Hari

Original languageEnglish
Article number8
JournalIntensive Care Medicine Experimental
Issue number1
PublishedDec 2022

Bibliographical note

Funding Information: LDB is supported by research grants from the innovative medicine initiative, the Dutch Lung Foundation (longfonds), Health Holland and Amsterdam UMC. LBW is supported by NIH HL158906. Publisher Copyright: © 2022, The Author(s).

King's Authors


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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