title: Personalized medicine for ARDS: the 2035 research agenda.
abstract: In the last 20 years, survival among patients with acute respiratory distress syndrome (ARDS) has increased substantially with advances in lung-protective ventilation and resuscitation. Building on this success, personalizing mechanical ventilation to patient-specific physiology for enhanced lung protection will be a top research priority for the years ahead. However, the ARDS research agenda must be broader in scope. Further understanding of the heterogeneous biology, from molecular to mechanical, underlying early ARDS pathogenesis is essential to inform therapeutic discovery and tailor treatment and prevention strategies to the individual patient. The ARDSne(x)t research agenda for the next 20 years calls for bringing personalized medicine to ARDS, asking simultaneously both whether a treatment affords clinically meaningful benefit and for whom. This expanded scope necessitates standard acquisition of highly granular biological, physiological, and clinical data across studies to identify biologically distinct subgroups that may respond differently to a given intervention. Clinical trials will need to consider enrichment strategies and incorporate long-term functional outcomes. Tremendous investment in research infrastructure and global collaboration will be vital to fulfilling this agenda.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, 200 West Arbor Drive, #8409, San Diego, CA, 92103, USA. jbeitler@ucsd.edu.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Beitler
authors.affiliation: Interdepartmental Division of Critical Care Medicine, Department of Physiology, University of Toronto, Toronto, Canada.
authors.forename: Ewan C
authors.initials: EC
authors.lastname: Goligher
authors.affiliation: Service de Réanimation Médicale, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Spieth
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanella
authors.affiliation: Multidisciplinary Intensive Care Research Organization (MICRO), Wellcome Trust - HRB Clinical Research, Department of Clinical Medicine, Trinity Centre for Health Sciences, St James's University Hospital, Dublin, Ireland.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martin-Loeches
authors.affiliation: Division of Pulmonary and Critical Care Medicine and Cardiovascular Research Institute, Departments of Medicine and Anesthesia, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Carolyn S
authors.initials: CS
authors.lastname: Calfee
authors.affiliation: Research Institute, HCor, Hospital do Coração, São Paulo, Brazil.
authors.forename: Alexandre B
authors.initials: AB
authors.lastname: Cavalcanti
mesh_terms: D035843:Biomedical Research; D002986:Clinical Trials as Topic; D003657:Decision Making; D005544:Forecasting; D006801:Humans; D057285:Precision Medicine; D012121:Respiration, Artificial / Q000639:trends; D012128:Respiratory Distress Syndrome / Q000628:therapy*
keywords: Acute lung injury; Acute respiratory distress syndrome; Clinical trials; Positive-pressure respiration; Respiratory mechanics; Ventilator-induced lung injury