Phenotypes in Acute Respiratory Distress Syndrome: what do they add?

Abstract

The pathophysiology of acute respiratory distress syndrome (ARDS) includes the accumulation of protein-rich pulmonary oedema in the air spaces and interstitial areas of the lung, variable degrees of epithelial injury, variable degrees of endothelial barrier disruption, transmigration of leukocytes, alongside impaired fluid and ion clearance. These pathophysiological features are different between patients contributing to substantial biological heterogeneity. This heterogeneity in ARDS is increasingly recognized as one of the principal barriers to finding efficacious targeted therapies. Phenotyping aims to use clinical, biological and other patient-related data to identify homogenous subgroups within an otherwise heterogeneous population. Increasingly, phenotyping schemas are being applied to ARDS to increase understanding of these clinical conditions and identify potential therapies. This talk will review the rationale for phenotyping and outline some of the challenges involved in translating these conceptual findings to bedside clinical decision-making tools.

About the speaker

John Laffey is Professor of Anesthesia and Critical Care Medicine at the University of Galway, Ireland. He is Director of Clinical Research at University of Galway and the Saolta University Hospital Group, and the director of the Lung Biology research group at the University of Galway. Past roles include Chair of the Irish Critical Care Trials Group, and Section Chair of the Translational Biology Section at the European Society of Intensive Care Medicine.
His research is focused on ARDS and sepsis, particularly the mechanisms underlying lung and systemic organ injury. He has a longstanding interest in the investigation of the mechanisms of action and therapeutic potential of cell therapies for critical illnesses. Other interests include the epidemiology of ARDS and weaning from mechanical ventilation. He has extensive experience of early phase and later phase clinical trials.