Ziaka Mairi, Exadaktylos Aristomenis
Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
J Clin Med. 2025 Jul 22;14(15):5184. doi: 10.3390/jcm14155184.
Increased epithelial and endothelial permeability, along with dysregulated inflammatory responses, are key aspects of acute respiratory distress syndrome (ARDS) pathophysiology, which not only impact the lungs but also contribute to detrimental organ crosstalk with distant organs, ultimately leading to multiple organ dysfunction syndrome (MODS)-the primary cause of morbidity and mortality in patients with lung injury (LI) and ARDS. It is predominantly manifested by hypoxemic respiratory failure and bilateral pulmonary infiltrates, which cannot be fully attributed to cardiac failure or hypervolemia, but rather to alveolo-capillary barrier dysfunction, dysregulated systemic and pulmonary inflammation, immune system abnormalities, and mechanical stimuli-related responses. However, these pathological features are not uniform among patients with ARDS, as distinct subphenotypes with unique biological, clinical, physiological, and radiographic characteristics have been increasingly recognized in recent decades. The severity of ARDS, clinical outcomes, mortality, and efficacy of applied therapeutic measures appear significant depending on the respective phenotype. Acknowledging the heterogeneity of ARDS and defining distinct subphenotypes could significantly modify therapeutic strategies, enabling more precise and targeted treatments. To address these issues, a comprehensive literature search was conducted in PubMed using predefined keywords related to ARDS pathophysiology, subphenotypes, and personalized therapeutic approaches. Optimizing the identification and characterization of discrete ARDS subphenotypes-based on clinical, biological, physiological, and radiographic criteria-will deepen our understanding of ARDS pathophysiology, promote targeted recruitment in prospective clinical studies to define patient clusters with heterogeneous therapeutic responses, and support the shift toward individualized treatment strategies.
上皮和内皮通透性增加，以及炎症反应失调，是急性呼吸窘迫综合征（ARDS）病理生理学的关键方面，这不仅会影响肺部，还会导致与远处器官有害的器官间相互作用，最终导致多器官功能障碍综合征（MODS）——这是肺损伤（LI）和ARDS患者发病和死亡的主要原因。其主要表现为低氧性呼吸衰竭和双侧肺部浸润，这不能完全归因于心力衰竭或血容量过多，而应归因于肺泡-毛细血管屏障功能障碍、全身和肺部炎症失调、免疫系统异常以及机械刺激相关反应。然而，这些病理特征在ARDS患者中并不一致，因为近几十年来，具有独特生物学、临床、生理和影像学特征的不同亚表型越来越受到认可。ARDS的严重程度、临床结果、死亡率以及应用治疗措施的疗效似乎因各自的表型而有显著差异。认识到ARDS的异质性并定义不同的亚表型可能会显著改变治疗策略，实现更精确和有针对性的治疗。为了解决这些问题，我们在PubMed中使用与ARDS病理生理学、亚表型和个性化治疗方法相关的预定义关键词进行了全面的文献检索。基于临床、生物学、生理和影像学标准优化离散ARDS亚表型的识别和特征描述，将加深我们对ARDS病理生理学的理解，促进前瞻性临床研究中的靶向招募，以定义具有异质性治疗反应的患者群体，并支持向个体化治疗策略的转变。
