Potential Impact of Subphenotyping in Pharmacologic Management of Acute Respiratory Distress Syndrome

被引:0
作者
Torbic, Heather [1 ,4 ]
Bulgarelli, Lucas [2 ]
Deliberato, Rodrigo Octavio [2 ]
Duggal, Abhijit [3 ]
机构
[1] Cleveland Clin, Dept Pharm, Cleveland, OH USA
[2] Endpoint Hlth Inc, Dept Clin Data Sci Res, Palo Alto, CA USA
[3] Cleveland Clin, Resp Inst, Dept Crit Care Med, Cleveland, OH USA
[4] Cleveland Clin, Dept Pharm, 9500 Euclid Ave,Hb-105 Cleveland, Cleveland, OH 44195 USA
关键词
acute respiratory distress syndrome; subphenotyping; pharmacology; NEUROMUSCULAR BLOCKING-AGENTS; INHALED NITRIC-OXIDE; ACUTE LUNG INJURY; ARDS; THERAPY; CARE; EPOPROSTENOL; GUIDELINES; BLOCKERS; SEPSIS;
D O I
10.1177/08971900231185392
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Background: Acute respiratory distress syndrome (ARDS) is an acute inflammatory process in the lungs associated with high morbidity and mortality. Previous research has studied both nonpharmacologic and pharmacologic interventions aimed at targeting this inflammatory process and improving ventilation. Hypothesis: To date, only nonpharmacologic interventions including lung protective ventilation, prone positioning, and high positive end-expiratory pressure ventilation strategies have resulted in significant improvements in patient outcomes. Given the high mortality associated with ARDS despite these advancements, interest in subphenotyping has grown, aiming to improve diagnosis and develop personalized treatment approaches. Data Collection: Previous trials evaluating pharmacologic therapies in heterogeneous populations have primarily demonstrated no positive effect, but hope to show benefit when targeting specific subphenotypes, thus increasing their efficacy, while simultaneously decreasing adverse effects. Results: Although most studies evaluating pharmacologic therapies for ARDS have not demonstrated a mortality benefit, there is limited data evaluating pharmacologic therapies in ARDS subphenotypes, which have found promising results. Neuromuscular blocking agents, corticosteroids, and simvastatin have resulted in a mortality benefit when used in patients with the hyper-inflammatory ARDS subphenotype. Therapeutic Opinion: The use of subphenotyping could revolutionize the way ARDS therapies are applied and therefore improve outcomes while also limiting the adverse effects associated with their ineffective use. Future studies should evaluate ARDS subphenotypes and their response to pharmacologic intervention to advance this area of precision medicine.
引用
收藏
页码:955 / 966
页数:12
相关论文
共 69 条
  • [61] Neuromuscular blocking agents for acute respiratory distress syndrome: how did we get conflicting results?
    Torbic, Heather
    Krishnan, Sudhir
    Duggal, Abhijit
    [J]. CRITICAL CARE, 2019, 23 (01):
  • [62] Neuromuscular blocking agents for acute respiratory distress syndrome
    Torbic, Heather
    Duggal, Abhijit
    [J]. JOURNAL OF CRITICAL CARE, 2019, 49 : 179 - 184
  • [63] Inhaled epoprostenol vs inhaled nitric oxide for refractory hypoxemia in critically ill patients
    Torbic, Heather
    Szumita, Paul M.
    Anger, Kevin E.
    Nuccio, Paul
    LaGambina, Susan
    Weinhouse, Gerald
    [J]. JOURNAL OF CRITICAL CARE, 2013, 28 (05) : 844 - 848
  • [64] Rosuvastatin for Sepsis-Associated Acute Respiratory Distress Syndrome
    Truwit, Jonathon D.
    Bernard, Gordon R.
    Steingrub, Jay
    Matthay, Michael A.
    Liu, Kathleen D.
    Albertson, Timothy E.
    Brower, Roy G.
    Shanholtz, Carl
    Rock, Peter
    Douglas, Ivor S.
    deBoisblanc, Bennett P.
    Hough, Catherine L.
    Hite, R. Duncan
    Thompson, B. Taylor
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2014, 370 (23) : 2191 - 2200
  • [65] Adjunctive Glucocorticoid Therapy in Patients with Septic Shock
    Venkatesh, B.
    Finfer, S.
    Cohen, J.
    Rajbhandari, D.
    Arabi, Y.
    Bellomo, R.
    Billot, L.
    Correa, M.
    Glass, P.
    Harward, M.
    Joyce, C.
    Li, Q.
    McArthur, C.
    Perner, A.
    Rhodes, A.
    Thompson, K.
    Webb, S.
    Myburgh, J.
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (09) : 797 - 808
  • [66] Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial
    Villar, Jesus
    Ferrando, Carlos
    Martinez, Domingo
    Ambros, Alfonso
    Munoz, Tomas
    Soler, Juan A.
    Aguilar, Gerardo
    Alba, Francisco
    Gonzalez-Higueras, Elena
    Conesa, Luis A.
    Martin-Rodriguez, Carmen
    Diaz-Dominguez, Francisco J.
    Serna-Grande, Pablo
    Rivas, Rosana
    Ferreres, Jose
    Belda, Javier
    Capilla, Lucia
    Tallet, Alec
    Anon, Jose M.
    Fernandez, Rosa L.
    Gonzalez-Martin, Jesus M.
    [J]. LANCET RESPIRATORY MEDICINE, 2020, 8 (03) : 267 - 276
  • [67] Current incidence and outcome of the acute respiratory distress syndrome
    Villar, Jesus
    Blanco, Jesus
    Kacmarek, Robert M.
    [J]. CURRENT OPINION IN CRITICAL CARE, 2016, 22 (01) : 1 - 6
  • [68] PERIPHERAL-NERVE FUNCTION IN SEPSIS AND MULTIPLE ORGAN FAILURE
    WITT, NJ
    ZOCHODNE, DW
    BOLTON, CF
    MAISON, FG
    WELLS, G
    YOUNG, GB
    SIBBALD, WJ
    [J]. CHEST, 1991, 99 (01) : 176 - 184
  • [69] Is Acute Respiratory Distress Syndrome a Preventable Disease?
    Yadav, Hemang
    Thompson, B. Taylor
    Gajic, Ognjen
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2017, 195 (06) : 725 - 736