Phenotypes and personalized medicine in the acute respiratory distress syndrome

Michael A. Matthay, Yaseen M. Arabi, Emily R. Siegel, Lorraine B. Ware, Lieuwe D.J. Bos, Pratik Sinha, Jeremy R. Beitler, Katherine D. Wick, Martha A.Q. Curley, Jean Michel Constantin, Joseph E. Levitt, Carolyn S. Calfee

Research output: Contribution to journalReview articlepeer-review

109 Scopus citations


Although the acute respiratory distress syndrome (ARDS) is well defined by the development of acute hypoxemia, bilateral infiltrates and non-cardiogenic pulmonary edema, ARDS is heterogeneous in terms of clinical risk factors, physiology of lung injury, microbiology, and biology, potentially explaining why pharmacologic therapies have been mostly unsuccessful in treating ARDS. Identifying phenotypes of ARDS and integrating this information into patient selection for clinical trials may increase the chance for efficacy with new treatments. In this review, we focus on classifying ARDS by the associated clinical disorders, physiological data, and radiographic imaging. We consider biologic phenotypes, including plasma protein biomarkers, gene expression, and common causative microbiologic pathogens. We will also discuss the issue of focusing clinical trials on the patient’s phase of lung injury, including prevention, administration of therapy during early acute lung injury, and treatment of established ARDS. A more in depth understanding of the interplay of these variables in ARDS should provide more success in designing and conducting clinical trials and achieving the goal of personalized medicine.

Original languageEnglish
Pages (from-to)2136-2152
Number of pages17
JournalIntensive care medicine
Issue number12
StatePublished - Dec 2020


  • Acute lung injury
  • Acute respiratory distress syndrome
  • COVID-19
  • Phenotype
  • Precision medicine
  • Pulmonary edema
  • Sepsis


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