Gong Michelle Ng, Thompson B Taylor
aDivision of Critical Care Medicine, Department of Medicine, Montefiore Medical Center bDepartment of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York cDepartment of Medicine, Pulmonary and Critical Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Crit Care. 2016 Feb;22(1):21-37. doi: 10.1097/MCC.0000000000000275.
Although results from clinical trials have advanced the treatment of acute respiratory distress syndrome (ARDS), mortality remains high. More recently, focus has shifted from treatment of ARDS to early identification and prevention in at-risk populations.
There have been 30 published and registered clinical trials with either the primary or secondary goal of reducing ARDS.
With this change in paradigm, come additional challenges and consideration in study design that depends not only on the intervention but also whether the intervention aims for a primary, secondary, or tertiary prevention of ARDS that targets a patient population for universal, selective, or indicated prevention. These epidemiologic concepts of prevention in public health also apply to ARDS and are relevant to the study population to target, the timing of the intervention relative to critical illness, the study design and outcomes to measure in an ARDS prevention study. This shift in focus is reflected by the new National Heart Lung Blood Institute Prevention and Early Treatment of Acute Lung Injury network, and signifies an overall movement away from reacting to and supporting acute organ failure after it is established to early detection and prevention in acute critical illness wherever and whenever it may occur.
尽管临床试验结果推动了急性呼吸窘迫综合征（ARDS）治疗的进展，但死亡率仍然很高。最近，重点已从ARDS的治疗转向高危人群的早期识别和预防。
已有30项已发表和注册的临床试验，其主要或次要目标是降低ARDS的发生率。
随着这种模式的转变，研究设计中出现了额外的挑战和需要考虑的因素，这不仅取决于干预措施，还取决于干预措施是旨在对ARDS进行一级、二级还是三级预防，以及针对的是普遍预防、选择性预防还是特定预防的患者群体。这些公共卫生领域的预防流行病学概念也适用于ARDS，并且与ARDS预防研究的目标研究人群、相对于危重病的干预时机、研究设计和测量结果相关。这种重点的转变体现在美国国立心肺血液研究所新的急性肺损伤预防和早期治疗网络中，标志着总体上从在急性器官衰竭发生后做出反应和提供支持，转向在急性危重病的任何时间和地点进行早期检测和预防。
