Acute respiratory distress syndrome (ARDS) is characterised by different pathogenetic pathways leading to similar clinical presentations. The mechanisms leading to ARDS are now better understood than ever; nevertheless, mortality remains high, probably due to biological heterogeneity, which hinders identification of an effective therapy. Therefore, recent studies have focused on identifying specific ARDS phenotypes in an attempt to improve diagnosis, optimise therapeutic interventions, and allow better selection of patients for future randomised controlled trials. Two different ARDS phenotypes (hyperinflammatory and hypoinflammatory) have been identified, showing differences in response to therapy and outcome. The hyperinflammatory phenotype is characterised by increased plasma levels of inflammatory biomarkers, vasopressor dependence, and prevalence of sepsis, as well as lower serum bicarbonate. However, this classification was based on analysis of 37 clinical parameters, which would not be feasible—or would at least be extraordinarily challenging—at the bedside. Within this context, a simple method to identify ARDS phenotypes would be a step towards the development of individually targeted therapeutic strategies. Similarly, in patients undergoing open abdominal surgery, two different phenotypes based on pre-operative plasma inflammatory serum biomarker concentrations have been identified and were able to distinguish patient groups with different incidences of postoperative pulmonary complications.

中文翻译：

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ARDS中个性化医学的关键方法。

急性呼吸窘迫综合征（ARDS）的特征是不同的致病途径导致相似的临床表现。现在比以往任何时候都更好地理解导致ARDS的机制。然而，死亡率可能仍然很高，这可能是由于生物学异质性所致，这阻碍了有效疗法的鉴定。因此，最近的研究集中于鉴定特定的ARDS表型，以试图改善诊断，优化治疗干预并为将来的随机对照试验更好地选择患者。已经鉴定出两种不同的ARDS表型（过度炎症性和次要炎症性），显示出对治疗和结果的反应差异。高炎症性表型的特征是血浆中炎症生物标志物水平升高，血管升压药依赖性，和败血症的患病率以及血清碳酸氢盐含量降低。但是，这种分类是基于对37个临床参数的分析，在床边这是不可行的，或者至少是非常具有挑战性的。在这种情况下，一种简单的识别ARDS表型的方法将是朝着制定针对性的治疗策略迈出的一步。同样，在接受开腹手术的患者中，已经根据术前血浆炎症血清生物标志物的浓度确定了两种不同的表型，并且能够区分术后肺部并发症发生率不同的患者组。在床边这是不可行的，或者至少是非常具有挑战性的。在这种情况下，一种简单的识别ARDS表型的方法将是朝着制定针对性的治疗策略迈出的一步。同样，在接受开腹手术的患者中，已经根据术前血浆炎症血清生物标志物的浓度确定了两种不同的表型，并且能够区分术后肺部并发症发生率不同的患者组。在床边这是不可行的，或者至少是非常具有挑战性的。在这种情况下，一种简单的识别ARDS表型的方法将是朝着制定针对性的治疗策略迈出的一步。同样，在接受开腹手术的患者中，已经根据术前血浆炎症血清生物标志物的浓度确定了两种不同的表型，并且能够区分术后肺部并发症发生率不同的患者组。