Materiały źródłowe

• #1 ClinConnect | Prevention of Ulinastatin on Acute Respiratory Distress

  https://clinconnect.io/trials/NCT03089957

  Since strategies were applied in intensive care medicine, including low tidal volume ventilation, fluid resuscitation, use of antibiotics, restrictive transfusion strategy and bundle of ventilator therapy, the incidence of Acute Respiratory Distress Syndrome (ARDS) has been decreased recent years. […] However, the mortality of severe ARDS is still higher to 45%. […] Few medications did were indicated to be effective in working on development of ARDS. […] Different with other disease, ARDS were difficult to prevent in its later stage like a domino effect.

• #2 Pharmacological treatments in ARDS; a state-of-the-art update | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-166

  Despite its high incidence and devastating outcomes, acute respiratory distress syndrome (ARDS) has no specific treatment, with effective therapy currently limited to minimizing potentially harmful ventilation and avoiding a positive fluid balance. […] Given their effective anti-inflammatory properties, there has been extensive interest in the potential role of corticosteroids in both the prevention and treatment of ARDS. High dose corticosteroids do not prevent ARDS in at risk subjects. […] Observational data associated pre-hospital anti-platelet use with a reduction in subsequent ARDS incidence. […] Clinical trials are planned to investigate the effect of aspirin on reducing inflammation in a human model of ARDS, while others are ongoing to assess the impact of aspirin in the prevention of ARDS.

• #3 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  Advances in critical care practice have led to a substantial decline in the incidence of ARDS over the past several years. Low tidal volume ventilation, timely resuscitation and antimicrobial administration, restrictive transfusion practices, and primary prevention of aspiration and nosocomial pneumonia have likely contributed to this reduction. […] Current initiatives have broadened the scope of lung injury research to include primary prevention of ARDS and prevention of morbidity among ARDS survivors. […] To facilitate these efforts, the National Institutes of Health has formed the Prevention and Early Treatment of Acute Lung Injury (PETAL) Network to conduct multicenter clinical trials aimed at further decreasing the disease burden of ARDS. […] Clinical trials targeting the prevention of ARDS face several key design challenges.

• #4 PETAL Network — About the network

  https://petalnet.org/

  The Clinical Trials Network for the Prevention and Early Treatment of Acute Lung Injury (PETAL Network) is a network of 12 Clinical Centers (CC) and 1 Clinical Coordinating Center (CCC) funded by the National Heart, Lung, and Blood Institute (NHLBI) to develop and conduct randomized controlled clinical trials to prevent or treat, and/or improve the outcome of patients who have, or who are at risk for, Acute Lung Injury (ALI) or Acute Respiratory Distress Syndrome (ARDS). […] The PETAL Networks goals and guiding principles included: (1) conduct 3-5 phase III clinical trials of prevention or early treatment of patients with or at risk for ARDS. […] Several hospitals will continue researching therapies for ARDS through participation in the National Institute of Allergy and Infectious Diseases (NIAID)-funded STRIVE Network, NHLBI-funded ARDS, Pneumonia, Sepsis Network (APS Consortium), and BARDA-funded ARDS clinical trials network.

• #5 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  Acute respiratory distress syndrome (ARDS) is common in critically ill patients admitted to intensive care units (ICU). […] Research focusing on preventing ARDS and identifying patients at risk of developing ARDS is necessary to develop strategies to alter the clinical course and progression of the disease. […] Identifying patients at risk and implementing prevention strategies in this group are key factors in preventing ARDS. […] This review will discuss early identification of at-risk patients and the current prevention strategies. […] The first obstacle to preventing ARDS is identifying patients at risk of developing ARDS. […] Implementing preventive measures requires an algorithm for early detection. […] The combination of early clinical recognition and predictive scores could help in the detection of patients at-risk and in the early treatment or implementation of preventive strategies.

• #6 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  More recently, angiopoietin-2 used together with LIPS was shown to predict subsequent development of ARDS better than either alone. […] Early phase multicenter randomized trials of aspirin, inhaled corticosteroids, and aerosolized 2-agonists are ongoing. […] A British group recently completed enrollment for a multicenter, double-blind, placebo-controlled, phase 2 trial testing whether IV KGF improves the oxygenation index in patients with ARDS.

• #7 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  Acute respiratory distress syndrome (ARDS) is common in critically ill patients admitted to intensive care units (ICU). […] Research focusing on preventing ARDS and identifying patients at risk of developing ARDS is necessary to develop strategies to alter the clinical course and progression of the disease. […] Identifying patients at risk and implementing prevention strategies in this group are key factors in preventing ARDS. […] This review will discuss early identification of at-risk patients and the current prevention strategies. […] The first obstacle to preventing ARDS is identifying patients at risk of developing ARDS. […] Implementing preventive measures requires an algorithm for early detection. […] The combination of early clinical recognition and predictive scores could help in the detection of patients at-risk and in the early treatment or implementation of preventive strategies.

• #8

  https://link.springer.com/article/10.1007/s00134-016-4280-0

  The first step to prevention of ARDS is to identify patients most likely to benefit from the prophylactic interventions. Several recent prevention studies selected patients undergoing surgical procedures in which there was substantial risk of postoperative ARDS, such as cardiac or esophageal surgeries. […] A reliable biomarker-driven approach could be of great value to identify high-risk patients or to identify patients most likely to benefit from a new intervention. […] Primary prevention aims to prevent disease or injury before it occurs. For ARDS this is only feasible in patients in whom the acute injury predisposing to ARDS can be predicted, such as those undergoing elective high-risk surgery or patients who need multiple transfusions. […] Secondary prevention aims to reduce the impact of a disease or injury, such as sepsis or aspiration, that has already occurred.

• #9 Clinical Strategies to Prevent Acute Respiratory Distress Syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31060094/

  Acute respiratory distress syndrome (ARDS) remains an important clinical entity in the intensive care unit with a significant impact on morbidity and mortality. Effective therapeutic interventions are limited; thus current research focus has shifted from treatment to the prevention of this pulmonary syndrome. […] In recent decades, a decrease in the incidence of ARDS has been observed and this reduction is largely due to preventive strategies including safe lung ventilation practices, avoidance of iatrogenic exposures, and improvement in care of predisposing conditions such as sepsis and pneumonia. […] Early identification of at-risk patients, prompt treatment of predisposing conditions, and adoption of evidence-based best practice including restrictive transfusion strategies, conservative fluid management, avoidance of large tidal volume ventilation, and aspiration precaution practices are key preventive strategies with demonstrated benefits. […] There are currently no effective pharmacological preventive strategies for ARDS.

• #10 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  Beyond the etiology, certain modifiable external factors can accelerate the development of ARDS. […] Lung-protective mechanical ventilation strategies are the only supportive therapy that clearly improve survival in patients with ARDS. […] Thus, it may be beneficial to implement protective ventilation strategies from the start of mechanical ventilation, not only when ARDS appears. […] In our opinion, preventive strategies also should include protective ventilation with low tidal volume in patients at risk, and some studies support this approach. […] The use of prophylactic PEEP in patients without ARDS is controversial. […] The most frequent etiology is pneumonia, followed by nonpulmonary infections. […] One of the most important preventive strategies is to ensure adequate management of sepsis, including source control and early appropriate antibiotic therapy.

• #11 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  Although multiple risk factors for ARDS are known, no successful preventive measures have been identified. […] Careful fluid management in high-risk patients may be helpful. Because aspiration pneumonitis is a risk factor for ARDS, taking appropriate measures to prevent aspiration (eg, elevating the head of the bed and evaluating swallowing mechanics before feeding high-risk patients) may also prevent some ARDS cases. […] In patients without ARDS on mechanical ventilation, the use of high tidal volumes appears to be a risk factor for the development of ARDS, and, therefore, the use of lower tidal volumes in all patients on mechanical ventilation may prevent some cases on ARDS. […] In situations where the patient requires the use of paralyzing agents to allow certain modes of mechanical ventilation, take meticulous care to ensure that an adequate alarm system is in place to alert staff to mechanical ventilator disconnection or malfunction. In addition, adequate sedation is important in most patients on ventilators and is essential when paralytic agents are in use.

• #12 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  The following review directly addresses these practical challenges for studies of ARDS prevention and discusses potential therapies for this novel indication, including those already under investigation in early stage trials. […] Measures to prevent aspiration and nosocomial pneumonia also may have contributed to the declining incidence of ARDS. […] In a single-center study, implementation of protocol-guided tidal volume and transfusion management was associated with a significantly lower incidence of ARDS. […] Together, these and other best practices in critical care have been bundled into the Checklist for Lung Injury Prevention (CLIP) to standardize care in clinical trials of ARDS prevention. […] Investigating new therapies targeting ARDS prevention necessitates reliable early identification of patients at risk for lung injury.

• #13 Prevention and treatment of acute lung injury with time-controlled adaptive ventilation: physiologically informed modification of airway pressure release ventilation | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0619-3

  Mortality in acute respiratory distress syndrome (ARDS) remains unacceptably high at approximately 39%. […] One of the only treatments is supportive: mechanical ventilation. […] Recent studies suggest that ventilation-induced lung injury (VILI) is caused by exaggerated regional lung strain, particularly in areas of alveolar instability subject to tidal recruitment/derecruitment and stress-multiplication. […] A time-controlled adaptive ventilation (TCAV) method was developed to minimize dynamic alveolar strain by adjusting the delivered breath according to the mechanical characteristics of the lung. […] The goal of this review is to describe how the TCAV method impacts pathophysiology and protects lungs with, or at high risk of, acute lung injury. […] The new paradigm in TCAV is configuring each breath guided by the previous one, which achieves real-time titration of ventilator settings and minimizes instability induced tissue damage.

• #14 Prevention and treatment of acute lung injury with time-controlled adaptive ventilation: physiologically informed modification of airway pressure release ventilation | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0619-3

  The outcome of this approach is an open and stable lung with reduced regional strain and greater lung protection. […] Current ARDS treatment is supportive: protective mechanical ventilation, typically using lower tidal volume ventilation (Vt) and lowmoderate positive end expiratory pressure (PEEP). […] The determinant of VILI is not the mode of ventilation, but the way parameters of the mechanical breath are set and combined. […] The goal of any protective mechanical breath should be maintaining functional residual capacity and increasing lung homogeneity. […] Efforts to minimize VILI, block progressive acute lung injury (ALI), and reduce ARDS mortality have resulted in two current approaches: (1) protect and rest the lung or (2) open the lung and keep it open (open lung approach OLA).

• #15 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  The following review directly addresses these practical challenges for studies of ARDS prevention and discusses potential therapies for this novel indication, including those already under investigation in early stage trials. […] Measures to prevent aspiration and nosocomial pneumonia also may have contributed to the declining incidence of ARDS. […] In a single-center study, implementation of protocol-guided tidal volume and transfusion management was associated with a significantly lower incidence of ARDS. […] Together, these and other best practices in critical care have been bundled into the Checklist for Lung Injury Prevention (CLIP) to standardize care in clinical trials of ARDS prevention. […] Investigating new therapies targeting ARDS prevention necessitates reliable early identification of patients at risk for lung injury.

• #16 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  Although multiple risk factors for ARDS are known, no successful preventive measures have been identified. […] Careful fluid management in high-risk patients may be helpful. Because aspiration pneumonitis is a risk factor for ARDS, taking appropriate measures to prevent aspiration (eg, elevating the head of the bed and evaluating swallowing mechanics before feeding high-risk patients) may also prevent some ARDS cases. […] In patients without ARDS on mechanical ventilation, the use of high tidal volumes appears to be a risk factor for the development of ARDS, and, therefore, the use of lower tidal volumes in all patients on mechanical ventilation may prevent some cases on ARDS. […] In situations where the patient requires the use of paralyzing agents to allow certain modes of mechanical ventilation, take meticulous care to ensure that an adequate alarm system is in place to alert staff to mechanical ventilator disconnection or malfunction. In addition, adequate sedation is important in most patients on ventilators and is essential when paralytic agents are in use.

• #17 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  An adequate policy of transfusion focused on less transfusion is perhaps the most important preventive strategy. […] To date, there is no specific pharmacologic treatment for the prevention of ALI/ARDS. […] Some new strategies and preliminary studies promise to improve the early identification and early intervention to prevent the progression of the disease. […] The combination of early clinical recognition and predictive scores could help to identify patients at risk and those who might progress to mild, moderate, or severe ARDS. […] The titration of tidal volume and the duration of mechanical ventilation in patients without ARDS seem to be the best strategy for prevention.

• #18 Clinical Strategies to Prevent Acute Respiratory Distress Syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31060094/

  Acute respiratory distress syndrome (ARDS) remains an important clinical entity in the intensive care unit with a significant impact on morbidity and mortality. Effective therapeutic interventions are limited; thus current research focus has shifted from treatment to the prevention of this pulmonary syndrome. […] In recent decades, a decrease in the incidence of ARDS has been observed and this reduction is largely due to preventive strategies including safe lung ventilation practices, avoidance of iatrogenic exposures, and improvement in care of predisposing conditions such as sepsis and pneumonia. […] Early identification of at-risk patients, prompt treatment of predisposing conditions, and adoption of evidence-based best practice including restrictive transfusion strategies, conservative fluid management, avoidance of large tidal volume ventilation, and aspiration precaution practices are key preventive strategies with demonstrated benefits. […] There are currently no effective pharmacological preventive strategies for ARDS.

• #19 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  Although multiple risk factors for ARDS are known, no successful preventive measures have been identified. […] Careful fluid management in high-risk patients may be helpful. Because aspiration pneumonitis is a risk factor for ARDS, taking appropriate measures to prevent aspiration (eg, elevating the head of the bed and evaluating swallowing mechanics before feeding high-risk patients) may also prevent some ARDS cases. […] In patients without ARDS on mechanical ventilation, the use of high tidal volumes appears to be a risk factor for the development of ARDS, and, therefore, the use of lower tidal volumes in all patients on mechanical ventilation may prevent some cases on ARDS. […] In situations where the patient requires the use of paralyzing agents to allow certain modes of mechanical ventilation, take meticulous care to ensure that an adequate alarm system is in place to alert staff to mechanical ventilator disconnection or malfunction. In addition, adequate sedation is important in most patients on ventilators and is essential when paralytic agents are in use.

• #20 NHLBI ARDS Network | About

  http://www.ardsnet.org/

  The NHLBI-funded Prevention and Treatment of Acute Lung Injury (PETAL) Network will begin work on prevention and early treatment of ARDS. […] Current management of ARDS begins with treatment and stabilization of the underlying disease that caused ARDS, such as early and effective antibiotics for pneumonia or sepsis. […] Conservative use of intravenous fluids combined with removal of excess fluids with diuretics lessens the need for mechanical ventilation.

• #21 Acute respiratory distress syndrome (ARDS) – Management Approach | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/374/management-approach

  A conservative fluid strategy reduced the duration of mechanical ventilation but had no effect on mortality in a large clinical trial in patients with ARDS who were not in shock. […] Prone positioning can improve oxygenation in patients with ARDS and has been shown to reduce mortality in patients with severe ARDS (PaO/FiO 150). […] Given the potential complications of prone positioning, including facial oedema, pressure sores, and dislodgement of catheters and endotracheal tubes, prone positioning should usually only be considered in patients with severe ARDS (PaO/FiO 150).

• #22 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  Beyond the etiology, certain modifiable external factors can accelerate the development of ARDS. […] Lung-protective mechanical ventilation strategies are the only supportive therapy that clearly improve survival in patients with ARDS. […] Thus, it may be beneficial to implement protective ventilation strategies from the start of mechanical ventilation, not only when ARDS appears. […] In our opinion, preventive strategies also should include protective ventilation with low tidal volume in patients at risk, and some studies support this approach. […] The use of prophylactic PEEP in patients without ARDS is controversial. […] The most frequent etiology is pneumonia, followed by nonpulmonary infections. […] One of the most important preventive strategies is to ensure adequate management of sepsis, including source control and early appropriate antibiotic therapy.

• #23 NHLBI ARDS Network | About

  http://www.ardsnet.org/

  The NHLBI-funded Prevention and Treatment of Acute Lung Injury (PETAL) Network will begin work on prevention and early treatment of ARDS. […] Current management of ARDS begins with treatment and stabilization of the underlying disease that caused ARDS, such as early and effective antibiotics for pneumonia or sepsis. […] Conservative use of intravenous fluids combined with removal of excess fluids with diuretics lessens the need for mechanical ventilation.

• #24 Clinical Strategies to Prevent Acute Respiratory Distress Syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31060094/

  Acute respiratory distress syndrome (ARDS) remains an important clinical entity in the intensive care unit with a significant impact on morbidity and mortality. Effective therapeutic interventions are limited; thus current research focus has shifted from treatment to the prevention of this pulmonary syndrome. […] In recent decades, a decrease in the incidence of ARDS has been observed and this reduction is largely due to preventive strategies including safe lung ventilation practices, avoidance of iatrogenic exposures, and improvement in care of predisposing conditions such as sepsis and pneumonia. […] Early identification of at-risk patients, prompt treatment of predisposing conditions, and adoption of evidence-based best practice including restrictive transfusion strategies, conservative fluid management, avoidance of large tidal volume ventilation, and aspiration precaution practices are key preventive strategies with demonstrated benefits. […] There are currently no effective pharmacological preventive strategies for ARDS.

• #25 Clinical Strategies to Prevent Acute Respiratory Distress Syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31060094/

  Acute respiratory distress syndrome (ARDS) remains an important clinical entity in the intensive care unit with a significant impact on morbidity and mortality. Effective therapeutic interventions are limited; thus current research focus has shifted from treatment to the prevention of this pulmonary syndrome. […] In recent decades, a decrease in the incidence of ARDS has been observed and this reduction is largely due to preventive strategies including safe lung ventilation practices, avoidance of iatrogenic exposures, and improvement in care of predisposing conditions such as sepsis and pneumonia. […] Early identification of at-risk patients, prompt treatment of predisposing conditions, and adoption of evidence-based best practice including restrictive transfusion strategies, conservative fluid management, avoidance of large tidal volume ventilation, and aspiration precaution practices are key preventive strategies with demonstrated benefits. […] There are currently no effective pharmacological preventive strategies for ARDS.

• #26 Antiplatelet Therapy for Acute Respiratory Distress Syndrome

  https://www.mdpi.com/2227-9059/8/7/230

  Aspirin is a well-known, irreversible, noncompetitive inhibitor of arachidonic acid cyclooxygenase metabolism and is commonly used in clinical practice. […] Preclinical studies have shown that aspirin can prevent or treat ARDS by decreasing neutrophil activation and recruitment to the lung, TNF-α expression in pulmonary intravascular macrophages, plasma TX B2 levels, and platelet sequestration in the lungs. […] Aspirin has significant antiplatelet properties through the inhibition of cyclooxygenase enzymes that prevent TXA2 production, therefore suppressing platelet aggregation in animal models of acute lung injury. […] Several observational studies have shown that aspirin is protective against the development of ARDS, and a large multicenter, double-blinded, randomized study showed no beneficial effect of aspirin on the development of ARDS. […] Future research should be based on ARDS patients whose phenotype pathology is more aligned with the mechanisms of antiplatelet therapy, and specific biomarkers should be developed to track their drug response.

• #27 Aspirin for prevention of acute respiratory distress syndrome (ARDS): let’s not throw the baby with the water!

  https://atm.amegroups.org/article/view/11433/html

  Kor et al. recently published the results of the LIPS-A trial. In this national multicenter randomized controlled trial, early aspirin administration (325 mg loading dose then 81 mg/day for 7 days) was compared to placebo in terms of reduction of acute respiratory distress syndrome (ARDS) occurrence during the first week after inclusion of patients at risk for ARDS. […] In the ARDS setting, animal studies tended to prove a beneficial effect of aspirin on ARDS prevention. […] Recent meta-analysis of nine cohort studies concluded that those patients admitted to emergency department or ICU and at risk for ARDS/ALI, who were receiving an antiplatelet drug before hospital admission (e.g., for cardiovascular prevention) had lower risk of mortality and ARDS/ALI occurrence. […] Any intervention trying to reduce ARDS incidence has to be considered with attention. […] Further research is needed in order to find better tools to predict the progression to ARDS. […] To conclude, we firmly believe that prevention of ARDS is a fundamental research target and should not be put aside.

• #28 Aspirin Ineffective Against ARDS Development | RT

  https://respiratory-therapy.com/disorders-diseases/critical-care/ards/aspirin-ineffective-ards-development/

  In a study published online by JAMA and presented at ATS 2016, May Clinic researchers evaluated the efficacy and safety of early aspirin administration for the prevention of acute respiratory distress syndrome (ARDS). […] Observational studies have suggested a potential preventive role for antiplatelet therapy in patients at high risk for ARDS. […] The researchers found that the administration of aspirin, compared with placebo, did not significantly reduce the incidence of ARDS at 7 days (20 patients [10.3%] in the aspirin group vs 17 patients [8.7%] in the placebo group). […] The findings of this phase 2b trial do not support continuation to a larger phase 3 trial, the authors wrote.

• #29 Aspirin falls short for the prevention of ARDS | MDedge

  https://community.the-hospitalist.org/content/aspirin-falls-short-prevention-ards

  SAN FRANCISCO Despite evidence implicating platelets in the development and resolution of acute respiratory distress syndrome (ARDS), the antiplatelet agent aspirin was not efficacious for prevention, according to the findings from a phase IIb trial reported at an international conference of the American Thoracic Society. […] In patients at risk for ARDS, aspirin therapy administered within 24 hours of presentation to the emergency department was safe. However, it did not decrease the primary outcome of ARDS development or improve any of the secondary outcomes, commented lead author Dr. Daryl J. Kor, an associate professor of anesthesiology at the Mayo Clinic, Rochester, Minn. The results of this phase IIb trial do not support continuation to a larger phase III trial. […] Nonetheless, as the first large multicenter ARDS prevention trial, LIPS-A provided an abundance of information about research in this challenging area, he stressed. For example, the information gleaned will help inform future trials on issues related to timely enrollment, risk prediction, and work flow modifications.

• #30 Aspirin falls short for the prevention of ARDS | MDedge

  https://community.the-hospitalist.org/content/aspirin-falls-short-prevention-ards

  Despite the negative LIPS-A findings, there may still be a role for aspirin in the treatment of ARDS, according to conference attendee Dr. Ivor S. Douglas, chief of pulmonary sciences and critical care medicine, and director of the medical intensive care unit, at the Denver Health Medical Center and the University of Colorado. […] LIPS-A enrolled adult patients from 16 U.S. academic hospitals who were at risk for ARDS, defined as having a Lung Injury Prediction Score of 4 or greater (corresponding to a risk of about 18%), in the emergency department and were planned to be hospitalized. […] Incident ARDS by day 7 was seen in 10.3% of the aspirin group and 8.7% of the placebo group, a nonsignificant difference. Findings were similar for each study site individually. […] In terms of safety, the incidence of bleeding-related adverse events was not significantly greater with aspirin than with placebo (5.6% vs. 2.6%). Measures of renal function were also essentially the same. […] Key clinical point: Aspirin therapy did not reduce the incidence of ARDS in at-risk patients. […] Major finding: Roughly 10% of patients developed ARDS, with no significant difference between the aspirin and placebo groups.

• #31 Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis | The BMJ

  https://www.bmj.com/content/336/7651/1006

  Objective To systematically review the efficacy of steroids in the prevention of acute respiratory distress syndrome (ARDS) in critically ill adults, and treatment for established ARDS. […] Preventive steroids possibly increase the incidence of ARDS in critically ill adults. […] The credible interval for the preventive use of steroids in critically ill patients included 1, indicating that a null effect could not be ruled out. The probability (odds ratio 1) was 86.6% suggesting some evidence of an association between steroid therapy and the subsequent development of ARDS: four studies, odds ratio 1.55 (95% credible interval 0.58 to 4.05); SD 0.58 for variability between studies. […] Although preventive steroid therapy in critically ill patients may have been associated with detrimental effects on the incidence of ARDS and subsequent mortality, a trend was found to benefit when steroids were given after the onset of ARDS; in particular, a reduction in odds of mortality (probability of reduction 93.2%).

• #32 Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis | The BMJ

  https://www.bmj.com/content/336/7651/1006

  Objective To systematically review the efficacy of steroids in the prevention of acute respiratory distress syndrome (ARDS) in critically ill adults, and treatment for established ARDS. […] Preventive steroids possibly increase the incidence of ARDS in critically ill adults. […] The credible interval for the preventive use of steroids in critically ill patients included 1, indicating that a null effect could not be ruled out. The probability (odds ratio 1) was 86.6% suggesting some evidence of an association between steroid therapy and the subsequent development of ARDS: four studies, odds ratio 1.55 (95% credible interval 0.58 to 4.05); SD 0.58 for variability between studies. […] Although preventive steroid therapy in critically ill patients may have been associated with detrimental effects on the incidence of ARDS and subsequent mortality, a trend was found to benefit when steroids were given after the onset of ARDS; in particular, a reduction in odds of mortality (probability of reduction 93.2%).

• #33 Corticosteroids May Reduce Ventilation Use, Duration in Patients With ARDS – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/news/meta-analyses-show-corticosteroid-use-in-acute-respiratory-distress-syndrome-reduces-icu-stays/

  Meta-analyses show that corticosteroids may reduce the risk of acute respiratory distress syndrome (ARDS) in patients with community-acquired pneumonia (CAP), reduce the duration of mechanical ventilation, and increase the number of ventilator-free days and days spent out of the intensive care unit (ICU) in patients with established ARDS, according to a review study published in the International Journal of Clinical Practice. […] With respect to corticosteroid use for ARDS prevention, researchers found corticosteroids were associated with significant reductions in ARDS occurrence in patients with CAP, but that corticosteroids appeared to have no significant effect on preventing ARDS in critically ill patients (OR, 1.55; 95% CI, 0.58-4.05). […] Overall, investigators said their review demonstrated the importance of corticosteroids, both as an adjunctive treatment for CAP and as a therapy that may reduce mechanical ventilation and ICU days, thus promoting faster recovery, a better quality of life, and lower health care costs.

• #34 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  More recently, angiopoietin-2 used together with LIPS was shown to predict subsequent development of ARDS better than either alone. […] Early phase multicenter randomized trials of aspirin, inhaled corticosteroids, and aerosolized 2-agonists are ongoing. […] A British group recently completed enrollment for a multicenter, double-blind, placebo-controlled, phase 2 trial testing whether IV KGF improves the oxygenation index in patients with ARDS.

• #35 Inhaled Sevoflurane for ARDS Prevention | Clinical Research Trial Listing

  https://www.centerwatch.com/clinical-trials/listings/NCT05849779/inhaled-sevoflurane-for-ards-prevention?phase3=true&activelyRecruiting=false&page=6&id=4&slug=acute-respiratory-distress-syndrome-ards

  This study focuses on patients who are at risk of developing a serious, life-threatening respiratory disease called Acute Respiratory Distress Syndrome (ARDS), which severely disrupts the function of their lungs. […] Preclinical studies have shown that the use of a volatile anesthetic agent such as Sevoflurane could be beneficial in the treatment and prevention of this respiratory condition. By improving gas exchange and attenuating pulmonary inflammation in particular, this agent would make it possible to prevent deterioration or to restore pulmonary function more rapidly. […] The aim of this study is to assess whether the use of Sevoflurane could be beneficial in the prevention of ARDS. […] MAIN OBJECTIVE To assess the efficacy of inhaled sevoflurane, compared to current intravenous sedation practice, for improving PaO2/FiO2 in ICU patients at high risk for ARDS. […] HYPOTHESIS The investigators hypothesized that a strategy of inhaled sedation with sevoflurane could be more effective than current intravenous sedation practice at improving pulmonary function during the early days of ICU admission, in patients at risk of ARDS.

• #36 Prophylaxis with tetracyclines in ARDS: Potential therapy for COVID-19-induced ARDS? | medRxiv

  https://www.medrxiv.org/content/10.1101/2020.07.22.20154542v1.full-text

  There is an immediate need for therapies related to coronavirus disease 2019 (COVID-19), especially candidate drugs that possess anti-inflammatory and immunomodulatory effects with low toxicity profiles. […] Here, we present a retrospective multi-institutional cohort study evaluating ventilatory status in patients who had taken a tetracycline antibiotic within a year prior to diagnosis of acute respiratory distress syndrome (ARDS). […] Minocycline or doxycycline treatment within a year prior to ARDS diagnosis was associated with a 75% reduced likelihood for mechanical ventilation during hospital stay. Furthermore, tetracycline antibiotic therapy corresponded to significant reductions in duration of mechanical ventilation and ICU stay in ARDS patients. These data suggest tetracyclines may provide prophylactic benefit in reducing ventilatory support for ARDS patients and support further evaluation in a randomized prospective trial.

• #37 Prophylaxis with tetracyclines in ARDS: Potential therapy for COVID-19-induced ARDS? | medRxiv

  https://www.medrxiv.org/content/10.1101/2020.07.22.20154542v1.full-text

  Our results proffer the potential for tetracyclines to provide prophylactic benefit in reducing ventilatory support and duration of ICU stay for ARDS patients. […] As tetracycline antibiotics are well tolerated and orally bioavailable, randomized prospective trials should be possible to further test their efficacy as a prophylactic therapy, specifically in patients at risk for the SARS-CoV-2 infection and development of ARDS.

• #38 ClinConnect | Prevention of Ulinastatin on Acute Respiratory Distress

  https://clinconnect.io/trials/NCT03089957

  Since strategies were applied in intensive care medicine, including low tidal volume ventilation, fluid resuscitation, use of antibiotics, restrictive transfusion strategy and bundle of ventilator therapy, the incidence of Acute Respiratory Distress Syndrome (ARDS) has been decreased recent years. […] However, the mortality of severe ARDS is still higher to 45%. […] Few medications did were indicated to be effective in working on development of ARDS. […] Different with other disease, ARDS were difficult to prevent in its later stage like a domino effect.

• #39 Clinical impact potential of Rejuveinix (RJX) for prevention of f

  https://www.openaccessjournals.com/articles/clinical-impact-potential-of-rejuveinix-rjx-for-prevention-of-fatal-acute-respiratory-distress-syndrome-ards-and-multiorgan-failur-13240.html

  RJX is an Intravenous (IV) formulation of known physiologically compatible compounds that is being developed for more effective supportive therapy of patients with sepsis, including COVID-19 patients with viral sepsis and Acute Respiratory Distress Syndrome (ARDS). […] The standard supportive care for ARDS patients is highly variable based on institutional preferences, and the fatality rate remains high with contemporary supportive care alone. Treatments that can effectively reduce the risk of ARDS or its mortality rate in high-risk patients with SARS-CoV-2 viremia or COVID-19 pneumonia are urgently needed. […] RJX has clinical impact potential for the prevention of imminent ARDS in the context of sepsis, including viral sepsis associated with COVID-19. […] It is hoped that RJX will reduce ALI and lung inflammation in COVID-19 patients with hypoxemic respiratory failure receiving either NIPPV or MV thereby shortening the time to resolution of the hypoxemic respiratory failure and reducing the case mortality rate when used in combination with standard of care.

• #40 Acute respiratory distress syndrome (ARDS) – Management Approach | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/374/management-approach

  The goals of treatment in patients with ARDS are supportive care and a protective strategy of lung ventilation using low tidal volumes to limit end inspiratory plateau pressure. […] If the suspected underlying cause of ARDS is infection, then the source should be identified and controlled, and antibiotics started immediately. Otherwise the immediate goals are supportive care and the prevention of complications. […] Standard supportive care of critically ill patients includes prevention of deep vein thrombosis, blood glucose control, prophylaxis against stress-induced gastrointestinal bleeding, haemodynamic support to maintain a mean arterial pressure 60 mmHg, and transfusion of packed red blood cells in patients with haemoglobin 70 g/L (7 g/dL). […] In patients who have an infectious cause for ARDS (e.g., pneumonia or sepsis), the prompt initiation of antimicrobials is important.

• #41 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0615/p730.html

  Prophylaxis for venous thromboembolism should be given to all patients hospitalized with ARDS. […] Patients with an anticipated ventilation requirement of at least 72 hours should be started on enteral nutrition. […] Stress ulcer prophylaxis should also be given. A randomized controlled trial found that intravenous pantoprazole (Protonix), 40 mg per day, decreased clinically important gastrointestinal bleeding compared with placebo.

• #42 The five P’s spell positive outcomes for ARDS patients

  https://www.myamericannurse.com/the-five-ps-spell-positive-outcomes-for-ards-patients/

  The five Ps of supportive therapy include perfusion, positioning, protective lung ventilation, protocol weaning, and preventing complications. […] Kinetic Therapy is effective in immobilized patients at angles up to 62 degrees. Kinetic Therapy effectively prevents and treats severe respiratory complications of prolonged immobilization. When started early, it prevents and treats pneumonia and ARDS, saving hospital resources and lives. […] Weaning protocols can reduce the time and cost of care while improving outcomes for ARDS patients. […] To prevent DVT, therapy including range-of-motion exercises, frequent position changes, anticoagulant prophylaxis, and use of sequential compression devices and thromboembolic stockings should start on admission. […] Nursing measures that may prevent this complication include relieving pressure with frequent position changes, restoring circulation with mobility, and promoting adequate nutrition.

• #43 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0615/p730.html

  Prophylaxis for venous thromboembolism should be given to all patients hospitalized with ARDS. […] Patients with an anticipated ventilation requirement of at least 72 hours should be started on enteral nutrition. […] Stress ulcer prophylaxis should also be given. A randomized controlled trial found that intravenous pantoprazole (Protonix), 40 mg per day, decreased clinically important gastrointestinal bleeding compared with placebo.

• #44 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0215/p352.html

  Treatment of acute respiratory distress syndrome is supportive and includes mechanical ventilation, prophylaxis for stress ulcers and venous thromboembolism, nutritional support, and treatment of the underlying injury. […] Patients should also be on stress ulcer prophylaxis with an agent such as sucralfate, ranitidine, or omeprazole to prevent venous thromboembolism, unless contraindicated. […] Conservative fluid therapy (targeting lower central pressures) in patients with ARDS may be associated with decreased days on a ventilator and increased days outside the intensive care unit.

• #45 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0615/p730.html

  Prophylaxis for venous thromboembolism should be given to all patients hospitalized with ARDS. […] Patients with an anticipated ventilation requirement of at least 72 hours should be started on enteral nutrition. […] Stress ulcer prophylaxis should also be given. A randomized controlled trial found that intravenous pantoprazole (Protonix), 40 mg per day, decreased clinically important gastrointestinal bleeding compared with placebo.

• #46 The five P’s spell positive outcomes for ARDS patients

  https://www.myamericannurse.com/the-five-ps-spell-positive-outcomes-for-ards-patients/

  The preferred support method is enteral nutrition because it causes fewer complications than parenteral nutrition. […] By putting the five evidence-based Ps into practice, you can safely steer clear of all the dangers, while improving your patients outcome and decreasing his length of stay in the ICU.

• #47 Acute respiratory distress syndrome (ARDS) – Management Approach | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/374/management-approach

  A conservative fluid strategy reduced the duration of mechanical ventilation but had no effect on mortality in a large clinical trial in patients with ARDS who were not in shock. […] Prone positioning can improve oxygenation in patients with ARDS and has been shown to reduce mortality in patients with severe ARDS (PaO/FiO 150). […] Given the potential complications of prone positioning, including facial oedema, pressure sores, and dislodgement of catheters and endotracheal tubes, prone positioning should usually only be considered in patients with severe ARDS (PaO/FiO 150).

• #48 Acute respiratory distress syndrome (ARDS) – Management Approach | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/374/management-approach

  A conservative fluid strategy reduced the duration of mechanical ventilation but had no effect on mortality in a large clinical trial in patients with ARDS who were not in shock. […] Prone positioning can improve oxygenation in patients with ARDS and has been shown to reduce mortality in patients with severe ARDS (PaO/FiO 150). […] Given the potential complications of prone positioning, including facial oedema, pressure sores, and dislodgement of catheters and endotracheal tubes, prone positioning should usually only be considered in patients with severe ARDS (PaO/FiO 150).

• #49 Frontiers | Pressure Injury Prevention in COVID-19 Patients With Acute Respiratory Distress Syndrome

  https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.558696/full

  Prior to positioning patients in prone position, the main recommendations are to (1) conduct a skin assessment, (2) use pressure redistribution devices, (3) select an appropriate mattress or an overlay, (4) ensure that the endotracheal tube securing device is removed and the endotracheal tube is secured with tapes, (5) use a liquid film-forming protective dressing, and (6) lubricate the eyes and tape them closed. […] Once a patient is in prone position, it is recommended to (1) use the swimmer’s position, (2) reposition the patient every 2 h, and (3) keep the skin clean. […] The main recommendation is to avoid the extended use of prone positioning unless required for the management of a medical condition. […] However, COVID-19 ARDS management requires prone positioning for extended periods of time, and therefore, using appropriate support surfaces and pillows and patient repositioning as soon as feasible are key preventive strategies recommended by the guidelines.

• #50 Frontiers | Pressure Injury Prevention in COVID-19 Patients With Acute Respiratory Distress Syndrome

  https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.558696/full

  Prior to positioning patients in prone position, the main recommendations are to (1) conduct a skin assessment, (2) use pressure redistribution devices, (3) select an appropriate mattress or an overlay, (4) ensure that the endotracheal tube securing device is removed and the endotracheal tube is secured with tapes, (5) use a liquid film-forming protective dressing, and (6) lubricate the eyes and tape them closed. […] Once a patient is in prone position, it is recommended to (1) use the swimmer’s position, (2) reposition the patient every 2 h, and (3) keep the skin clean. […] The main recommendation is to avoid the extended use of prone positioning unless required for the management of a medical condition. […] However, COVID-19 ARDS management requires prone positioning for extended periods of time, and therefore, using appropriate support surfaces and pillows and patient repositioning as soon as feasible are key preventive strategies recommended by the guidelines.

• #51 Acute Respiratory Distress Syndrome (ARDS)

  https://my.clevelandclinic.org/health/diseases/15283-acute-respiratory-distress-syndrome-ards

  Can you prevent acute respiratory distress syndrome (ARDS)? […] Theres no way to prevent acute respiratory distress syndrome (ARDS). But you may be able to prevent it from being severe by seeking immediate medical attention if you have symptoms of respiratory distress, or if you have a lung injury or other disease. You can lower your risk of getting severe ARDS by quitting smoking and avoiding alcohol.

• #52 ARDS: Causes, Symptoms, Risks, Diagnosis, and TreatmentHealthline

  https://www.healthline.com/health/acute-respiratory-distress-syndrome

  Preventing acute respiratory distress syndrome […] There’s no way to prevent ARDS completely. However, you may be able to lower your risk of ARDS by doing the following: […] Seek prompt medical assistance for any trauma, infection, or illness. […] If you smoke, consider stopping smoking cigarettes. […] Try to stay away from secondhand smoke. […] Avoid alcohol. Chronic alcohol use may increase your mortality risk and prevent proper lung function. […] Get your flu vaccine annually and pneumonia vaccine every 5 years. This decreases your risk of lung infections.

• #53

  https://www.advocatehealth.com/health-services/lung-respiratory-care/acute-respiratory-distress-syndrome-ards

  You can lower your risk of ARDS by avoiding tobacco smoke, limiting alcohol, limiting exposure to pollution, and getting vaccinated for the flu, COVID and other infections.

• #54 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  Advances in critical care practice have led to a substantial decline in the incidence of ARDS over the past several years. Low tidal volume ventilation, timely resuscitation and antimicrobial administration, restrictive transfusion practices, and primary prevention of aspiration and nosocomial pneumonia have likely contributed to this reduction. […] Current initiatives have broadened the scope of lung injury research to include primary prevention of ARDS and prevention of morbidity among ARDS survivors. […] To facilitate these efforts, the National Institutes of Health has formed the Prevention and Early Treatment of Acute Lung Injury (PETAL) Network to conduct multicenter clinical trials aimed at further decreasing the disease burden of ARDS. […] Clinical trials targeting the prevention of ARDS face several key design challenges.

• #55 Aspirin for prevention of acute respiratory distress syndrome (ARDS): let’s not throw the baby with the water!

  https://atm.amegroups.org/article/view/11433/html

  Kor et al. recently published the results of the LIPS-A trial. In this national multicenter randomized controlled trial, early aspirin administration (325 mg loading dose then 81 mg/day for 7 days) was compared to placebo in terms of reduction of acute respiratory distress syndrome (ARDS) occurrence during the first week after inclusion of patients at risk for ARDS. […] In the ARDS setting, animal studies tended to prove a beneficial effect of aspirin on ARDS prevention. […] Recent meta-analysis of nine cohort studies concluded that those patients admitted to emergency department or ICU and at risk for ARDS/ALI, who were receiving an antiplatelet drug before hospital admission (e.g., for cardiovascular prevention) had lower risk of mortality and ARDS/ALI occurrence. […] Any intervention trying to reduce ARDS incidence has to be considered with attention. […] Further research is needed in order to find better tools to predict the progression to ARDS. […] To conclude, we firmly believe that prevention of ARDS is a fundamental research target and should not be put aside.

• #56 Pharmacological treatments in ARDS; a state-of-the-art update | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-166

  Collectively, these data provide encouragement for future clinical trials in this area. […] Despite many interventions being studied, to date there has been little success in developing effective pharmacological therapies for the management of ARDS. However, given the high associated morbidity and mortality, pressure remains to continue efforts to improve outcomes. Increasing numbers of pharmacological therapies are being investigated, and with encouraging pre-clinical and early clinical results, it is expected that over the coming years some will develop into useful agents for the prevention and treatment of ARDS.

• #57 PETAL Network — About the network

  https://petalnet.org/

  The Clinical Trials Network for the Prevention and Early Treatment of Acute Lung Injury (PETAL Network) is a network of 12 Clinical Centers (CC) and 1 Clinical Coordinating Center (CCC) funded by the National Heart, Lung, and Blood Institute (NHLBI) to develop and conduct randomized controlled clinical trials to prevent or treat, and/or improve the outcome of patients who have, or who are at risk for, Acute Lung Injury (ALI) or Acute Respiratory Distress Syndrome (ARDS). […] The PETAL Networks goals and guiding principles included: (1) conduct 3-5 phase III clinical trials of prevention or early treatment of patients with or at risk for ARDS. […] Several hospitals will continue researching therapies for ARDS through participation in the National Institute of Allergy and Infectious Diseases (NIAID)-funded STRIVE Network, NHLBI-funded ARDS, Pneumonia, Sepsis Network (APS Consortium), and BARDA-funded ARDS clinical trials network.

• #58

  https://link.springer.com/article/10.1007/s00134-016-4331-6

  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. […] 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. […] 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. […] Beitler JR, Schoenfeld DA, Thompson BT (2014) Preventing ARDS: progress, promise, and pitfalls. Chest 146:11021113.

• #59 Clinical Strategies to Prevent Acute Respiratory Distress Syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31060094/

  Acute respiratory distress syndrome (ARDS) remains an important clinical entity in the intensive care unit with a significant impact on morbidity and mortality. Effective therapeutic interventions are limited; thus current research focus has shifted from treatment to the prevention of this pulmonary syndrome. […] In recent decades, a decrease in the incidence of ARDS has been observed and this reduction is largely due to preventive strategies including safe lung ventilation practices, avoidance of iatrogenic exposures, and improvement in care of predisposing conditions such as sepsis and pneumonia. […] Early identification of at-risk patients, prompt treatment of predisposing conditions, and adoption of evidence-based best practice including restrictive transfusion strategies, conservative fluid management, avoidance of large tidal volume ventilation, and aspiration precaution practices are key preventive strategies with demonstrated benefits. […] There are currently no effective pharmacological preventive strategies for ARDS.

• #60 Pharmacological treatments in ARDS; a state-of-the-art update | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-166

  Collectively, these data provide encouragement for future clinical trials in this area. […] Despite many interventions being studied, to date there has been little success in developing effective pharmacological therapies for the management of ARDS. However, given the high associated morbidity and mortality, pressure remains to continue efforts to improve outcomes. Increasing numbers of pharmacological therapies are being investigated, and with encouraging pre-clinical and early clinical results, it is expected that over the coming years some will develop into useful agents for the prevention and treatment of ARDS.

• #61

  https://link.springer.com/article/10.1007/s00134-016-4331-6

  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. […] 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. […] 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. […] Beitler JR, Schoenfeld DA, Thompson BT (2014) Preventing ARDS: progress, promise, and pitfalls. Chest 146:11021113.

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