Focus on ventilation and ARD: recent insights

Excerpt

The year 2018 in mechanical ventilation and acute respiratory distress syndrome (ARDS) was marked by the struggle to develop personalized or precision medicine, defined as “the tailoring of medical treatment to the individual characteristics of each patient with ARDS”. Despite many recent efforts made performing large randomized clinical trials, their results often remain indeterminate in unselected ARDS patients [1]. In a randomized trial involving patients with very severe ARDS [2], early application of venovenous extracorporeal membrane oxygenation (VV-ECMO) did not result in a statistically significant reduction in the primary endpoint of 60-day mortality. However, the large absolute 11% reduction in mortality seen despite the fact that 28% of control patients crossed over to ECMO for refractory hypoxemia, suggests that many patients with severe ARDS could benefit from VV-ECMO therapy. On the other hand, therapies with proven efficacy for decreasing mortality in ARDS patients remain inconsistently applied in clinical practice. A prospective international prevalence study found that prone position was used in only 32.9% of severe ARDS patients [3]. The discordance between the application of therapies at the bedside and results of large trials might reflect the use of precision medicine by bedside physicians. Moreover, it is worth noting that a lot of patients were excluded from large ARDS studies according to their comorbidities [4], which further increases the gap between clinical trials and actual clinical practice. …