Opportunities for improved clinical trial designs in acute respiratory distress syndrome

Katherine D. Wick, Neil R. Aggarwal, Martha A.Q. Curley, Alpha A. Fowler, Samir Jaber, Maciej Kostrubiec, Nathalie Lassau, Pierre François Laterre, Guillaume Lebreton, Joseph E. Levitt, Alexandre Mebazaa, Eileen Rubin, Pratik Sinha, Lorraine B. Ware, Michael A. Matthay

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations


The acute respiratory distress syndrome (ARDS) is a common critical illness syndrome with high morbidity and mortality. There are no proven pharmacological therapies for ARDS. The current definition of ARDS is based on shared clinical characteristics but does not capture the heterogeneity in clinical risk factors, imaging characteristics, physiology, timing of onset and trajectory, and biology of the syndrome. There is increasing interest within the ARDS clinical trialist community to design clinical trials that reduce heterogeneity in the trial population. This effort must be balanced with ongoing work to craft an inclusive, global definition of ARDS, with important implications for trial design. Ultimately, the two aims—to design trials that are applicable to the diverse global ARDS population while also advancing opportunities to identify targetable traits—should coexist. In this Personal View, we recommend two primary strategies to improve future ARDS trials: the development of new methods to target treatable traits in clinical trial populations, and improvements in the representativeness of ARDS trials, with the inclusion of global populations. We emphasise that these two strategies are complementary. We also discuss how a proposed expansion of the definition of ARDS could affect the future of clinical trials.

Original languageEnglish
Pages (from-to)916-924
Number of pages9
JournalThe Lancet Respiratory Medicine
Issue number9
StatePublished - Sep 2022


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