Personalized medicine for ARDS: the 2035 research agenda.
Personalized medicine for ARDS: the 2035 research agenda.
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DOI：
10.1007/s00134-016-4331-6
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发表时间：
2016-05
影响因子：
38.9
通讯作者：
ARDSne(x)t Investigators
中科院分区：
文献类型：
--
作者：
Beitler JR;Goligher EC;Schmidt M;Spieth PM;Zanella A;Martin-Loeches I;Calfee CS;Cavalcanti AB;ARDSne(x)t Investigators
由于肺保护性通气和复苏的关键进展，在过去的二十年中，ARDS的生存率大幅提高。同样，临床实践的改进也使医院内ARDS发生率显著下降。个性化机械通气以进一步保护肺是未来几年的首要研究重点。然而，ARDS的研究议程必须更广泛的范围。ARDS的临床综合征包括导致肺损伤的多种病理生理过程。进一步了解这些不同的，复杂的生物学基础的ARDS发病机制是必要的，以告知治疗的发现和定制的管理策略，以个别患者。虽然一些疗法可能广泛适用于所有ARDS患者，但其他疗法可能仅对某些生物学上不同的亚群有益。20年的ARDSne（x）t研究议程要求为ARDS提供个性化医疗，同时询问治疗是否提供有临床意义的益处以及为谁提供。这种扩展的范围需要采集高度颗粒化的生物学、生理学和临床数据，作为跨研究的新标准。对研究基础设施和全球合作的巨大投资对实现这一议程至关重要。
Survival from ARDS has increased substantially in the last twenty years as a result of key advances in lung-protective ventilation and resuscitation. Similarly, clinical practice improvements have contributed to an impressive decline in nosocomial ARDS incidence. Personalizing mechanical ventilation for further lung protection is a top research priority for the years ahead. However, the ARDS research agenda must be broader in scope. The clinical syndrome of ARDS includes a heterogeneous assemblage of pathophysiological processes leading to lung injury. Further understanding of these varied, complex biological underpinnings of ARDS pathogenesis is needed to inform therapeutic discovery and tailor management strategy to the individual patient. While some therapies may be applicable broadly to all ARDS patients, others may benefit only certain biologically distinct subsets. The twenty-year ARDSne(x)t research agenda calls for bringing personalized medicine to ARDS, asking simultaneously both whether a treatment affords clinically meaningful benefit and for whom. This expanded scope necessitates acquisition of highly granular biological, physiological, and clinical data as the new standard across studies. Tremendous investment in research infrastructure and global collaboration will be vital to fulfilling this agenda.