Personalized medicine targeting different ARDS phenotypes: The future of pharmacotherapy for ARDS?

ABSTRACT

Introduction

Acute respiratory distress syndrome (ARDS) still represents a major challenge with high mortality rates and altered quality of life. Many well-designed studies have failed to improve ARDS outcomes. Heterogeneity of etiologies, mechanisms of lung damage, different lung mechanics, and different treatment approaches may explain these failures. At the era of personalized medicine, ARDS phenotyping is not only a field of research, but a bedside consideration when implementing therapy. ARDS has moved from being a simple syndrome to a more complex area of subgrouping. Intensivists must understand these phenotypes and therapies associated with a better outcome.

Areas covered

After a brief sum-up of the different type of ARDS phenotypes, we will present some relevant therapy that may be impacted by phenotyping. A focus on pharmacotherapy will be realized before a section on non-pharmaceutical strategies. Eventually, we will highlight the limits of our knowledge of phenotyping and the pitfalls of personalized medicine.

Expert opinion

Biological and morphological ARDS phenotypes are now well studied. The future of ARDS therapy will go through phenotyping that allows a personalized medication for each patient. However, a better assessment of these phenotypes is required, and clinical trials should be conducted with an ad-hoc phenotyping before randomization.

KEYWORDS:

• Acute respiratory syndrome
• ICU
• personalized medicine
• pharmacotherapy
• phenotype
• therapy

Article highlights

• Personalized medicine in ARDS has never been so close to patients’ bedside.

• Using personalized medicine in ARDS may help avoid heterogeneity.

• Patients can be classified using biological phenotypes (hypoinflammatory or hyperinflammatory ARDS) and morphological phenotypes (focal and non-focal ARDS).

• In 2022, depending on the biological phenotype of the ARDS, the use of simvastatin, PEEP, and fluid administration were associated with different outcomes.

• Other promising therapies may result in different outcomes, depending on the underlying biological or morphological phenotype.

• Multiple issues still need to be resolved before implementing a daily use of personalized medicine in ARDS.

Declaration of interests

J-M Constantin reports personal fees and non-financial support from Drager, GE Healthcare, Sedana Medical, Baxter, and Amomed; personal fees from Fisher and Paykel Healthcare, Orion, Philips Medical, and Fresenius Medical Care; and non-financial support from LFB and Bird Corporation, outside of the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by Sorbonne university