急性呼吸窘迫综合征相关临床研究：现状与挑战

罗薇薇; 黄添姹; 张召才

doi:10.14188/j.1671-8852.2024.0493

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急性呼吸窘迫综合征相关临床研究：现状与挑战

急性呼吸窘迫综合征专题研究 | 更新时间：2026-11-05

- 急性呼吸窘迫综合征相关临床研究：现状与挑战
- Clinical trials related to acute respiratory distress syndrome: Current status and challenges
- 武汉大学学报（医学版） 2025年46卷第2期页码：232-238
- 作者机构：
  
  浙江大学医学院附属第二医院重症医学科/浙江省急危重症临床医学研究中心浙江杭州 310009
- 作者简介：
  
  罗薇薇，女，1999—，医学硕士生，主要从事重症医学研究，E⁃mail:22318482@zju.edu.cn
  张召才，男，1971—，教授，主任医师，博士生导师，主要从事脓毒症心肌病、ARDS、MODS研究，E⁃mail:2313003@zju.edu.cn
- 基金信息：
  
  国家重点研发计划项目(2021YFC2501800)
- DOI：10.14188/j.1671-8852.2024.0493
  中图分类号： R563.8
- 收稿：2024-07-03，
  
  纸质出版：2025-02-25
- 稿件说明：
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罗薇薇,黄添姹,张召才.急性呼吸窘迫综合征相关临床研究：现状与挑战[J].武汉大学学报（医学版）,2025,46(02):232-238.

LUO Weiwei,HUANG Tiancha,ZHANG Zhaocai.Clinical trials related to acute respiratory distress syndrome: Current status and challenges[J].Medical Journal of Wuhan University,2025,46(02):232-238.
罗薇薇,黄添姹,张召才.急性呼吸窘迫综合征相关临床研究：现状与挑战[J].武汉大学学报（医学版）,2025,46(02):232-238. DOI： 10.14188/j.1671-8852.2024.0493.

LUO Weiwei,HUANG Tiancha,ZHANG Zhaocai.Clinical trials related to acute respiratory distress syndrome: Current status and challenges[J].Medical Journal of Wuhan University,2025,46(02):232-238. DOI： 10.14188/j.1671-8852.2024.0493.

摘要

急性呼吸窘迫综合征（ARDS）是由各种肺内或肺外因素导致的临床综合征，发病率和死亡率高。关于ARDS的治疗探索从未停滞，但相关临床研究陷入困境，保护性机械通气策略仍是当前唯一被证实有效的标准疗法，其原因可能与ARDS的高度异质性有关。本文聚焦于ARDS相关的临床研究，通过分析临床治疗的现状和挑战，提出增进ARDS临床研究客观性和精准性的建议。

Abstract

Acute respiratory distress syndrome (ARDS) is a clinical syndrome caused by various pulmonary or extrapulmonary factors

with high morbidity and mortality. The exploration of treatments for ARDS has never stopped

but related clinical research has encountered difficulties. Protective mechanical ventilation strategy remains the only proven effective standard therapy

which may be related to the high heterogeneity of ARDS. This article focuses on clinical trials related to ARDS

analyzes the current situation and challenges of clinical treatment

and proposes suggestions to improve the objectivity and accuracy of ARDS clinical trials.

关键词

Keywords

references

Ashbaugh D G , Bigelow D B , Petty T L , et al . Acute respiratory distress in adults [J ] . Lancet , 1967 , 2 ( 7511 ): 319 ⁃ 323 .

Bellani G , Laffey J G , Pham T , et al . Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries [J ] . JAMA , 2016 , 315 ( 8 ): 788 ⁃ 800 .

Tzotzos S J , Fischer B , Fischer H , et al . Incidence of ARDS and outcomes in hospitalized patients with COVID⁃19: A global literature survey [J ] . Crit Care , 2020 , 24 ( 1 ): 516 .

Banavasi H , Nguyen P , Osman H , et al . Management of ARDS — What works and what does not [J ] . Am J Med Sci , 2021 , 362 ( 1 ): 13 ⁃ 23 .

ARDS Definition Task Force , Ranieri V M , Rubenfeld G D , et al . Acute respiratory distress syndrome:The Berlin Definition [J ] . JAMA , 2012 , 307 ( 23 ): 2526 ⁃ 2533 .

Murray J F , Matthay M A , Luce J M , et al . An expanded definition of the adult respiratory distress syndrome [J ] . Am Rev Respir Dis , 1988 , 138 ( 3 ): 720 ⁃ 723 .

Bernard G R , Artigas A , Brigham K L , et al . The American⁃European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination [J ] . Am J Respir Crit Care Med , 1994 , 149 ( 3 Pt 1 ): 818 ⁃ 824 .

Wick K D , Matthay M A , Ware L B . Pulse oximetry for the diagnosis and management of acute respiratory distress syndrome [J ] . Lancet Respir Med , 2022 , 10 ( 11 ): 1086 ⁃ 1098 .

Smit M R , Hagens L A , Heijnen N F L , et al . Lung ultrasound prediction model for acute respiratory distress syndrome: A multicenter prospective observational study [J ] . Am J Respir Crit Care Med , 2023 , 207 ( 12 ): 1591 ⁃ 1601 .

Matthay M A , Arabi Y , Arroliga A C , et al . A new global definition of acute respiratory distress syndrome [J ] . Am J Respir Crit Care Med , 2024 , 209 ( 1 ): 37 ⁃ 47 .

Keskinidou C , Vassiliou A G , Papoutsi E , et al . Dysregulated coagulation and fibrinolysis are present in patients admitted to the emergency department with acute hypoxemic respiratory failure: A prospective study [J ] . Biomedicines , 2024 , 12 ( 5 ): 1081 .

Heijnen N F L , Hagens L A , Smit M R , et al . Biological subphenotypes of acute respiratory distress syndrome show prognostic enrichment in mechanically ventilated patients without acute respiratory distress syndrome [J ] . Am J Respir Crit Care Med , 2021 , 203 ( 12 ): 1503 ⁃ 1511 .

Khan Y A , Fan E , Ferguson N D . Precision medicine and heterogeneity of treatment effect in therapies for ARDS [J ] . Chest , 2021 , 160 ( 5 ): 1729 ⁃ 1738 .

Kneyber M C J , Khemani R G , Bhalla A , et al . Understanding clinical and biological heterogeneity to advance precision medicine in paediatric acute respiratory distress syndrome [J ] . Lancet Respir Med , 2023 , 11 ( 2 ): 197 ⁃ 212 .

Xu H K , Sheng S Y , Luo W W , et al . Acute respiratory distress syndrome heterogeneity and the septic ARDS subgroup [J ] . Front Immunol , 2023 , 14 : 1277161 .

尹俊 , 宋振举 . ARDS的精准治疗 [J ] . 武汉大学学报(医学版) , 2023 , 44 ( 11 ): 1291 ⁃ 1295 .

Yin J , Song Z J . Precision medicine for the treatment of ARDS [J ] . Medical Journal of Wuhan University , 2023 , 44 ( 11 ): 1291 ⁃ 1295 .

Network A R D S , Brower R G , Matthay M A , et al . Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome [J ] . N Engl J Med , 2000 , 342 ( 18 ): 1301 ⁃ 1308 .

Aoyama H , Uchida K , Aoyama K , et al . Assessment of therapeutic interventions and lung protective ventilation in patients with moderate to severe acute respiratory distress syndrome: A systematic review and network meta⁃analysis [J ] . JAMA Netw Open , 2019 , 2 ( 7 ): e198116 .

Fan E , Needham D M , Stewart T E . Ventilatory management of acute lung injury and acute respiratory distress syndrome [J ] . JAMA , 2005 , 294 ( 22 ): 2889 ⁃ 2896 .

Needham D M , Colantuoni E , Mendez⁃Tellez P A , et al . Lung protective mechanical ventilation and two year survival in patients with acute lung injury: Prospective cohort study [J ] . BMJ , 2012 , 344 : e2124 .

Petrucci N , De Feo C . Lung protective ventilation strategy for the acute respiratory distress syndrome [J ] . Cochrane Database Syst Rev , 2013 , 2013 ( 2 ): CD003844 .

McNamee J J , Gillies M A , Barrett N A , et al . Effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal vs standard care ventilation on 90⁃day mortality in patients with acute hypoxemic respiratory failure: The REST randomized clinical trial [J ] . JAMA , 2021 , 326 ( 11 ): 1013 ⁃ 1023 .

Grieco D L , Maggiore S M , Roca O , et al . Non⁃invasive ventilatory support and high⁃flow nasal oxygen as first⁃line treatment of acute hypoxemic respiratory failure and ARDS [J ] . Intensive Care Med , 2021 , 47 ( 8 ): 851 ⁃ 866 .

Mauri T , Galazzi A , Binda F , et al . Impact of flow and temperature on patient comfort during respiratory support by high⁃flow nasal cannula [J ] . Crit Care , 2018 , 22 ( 1 ): 120 .

Ferrando C , Suarez⁃Sipmann F , Mellado⁃Artigas R , et al . Clinical features, ventilatory management, and outcome of ARDS caused by COVID⁃19 are similar to other causes of ARDS [J ] . Intensive Care Med , 2020 , 46 ( 12 ): 2200 ⁃ 2211 .

Meade M O , Young D , Hanna S , et al . Severity of hypoxemia and effect of high⁃frequency oscillatory ventilation in acute respiratory distress syndrome [J ] . Am J Respir Crit Care Med , 2017 , 196 ( 6 ): 727 ⁃ 733 .

Zhu X W , Qi H B , Feng Z C , et al . Noninvasive high⁃frequency oscillatory ventilation vs nasal continuous positive airway pressure vs nasal intermittent positive pressure ventilation as postextubation support for preterm neonates in China: A randomized clinical trial [J ] . JAMA Pediatr , 2022 , 176 ( 6 ): 551 ⁃ 559 .

Carsetti A , Damiani E , Domizi R , et al . Airway pressure release ventilation during acute hypoxemic respiratory failure: A systematic review and meta⁃analysis of randomized controlled trials [J ] . Ann Intensive Care , 2019 , 9 ( 1 ): 44 .

Combes A , Peek G J , Hajage D , et al . ECMO for severe ARDS: Systematic review and individual patient data meta⁃analysis [J ] . Intensive Care Med , 2020 , 46 ( 11 ): 2048 ⁃ 2057 .

Grissom C K , Hirshberg E L , Dickerson J B , et al . Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome [J ] . Crit Care Med , 2015 , 43 ( 2 ): 288 ⁃ 295 .

Battaglini D , Iavarone I G , Rocco P R M . An update on the pharmacological management of acute respiratory distress syndrome [J ] . Expert Opin Pharmacother , 2024 , 25 ( 9 ): 1229 ⁃ 1247 .

Calfee C S , Delucchi K L , Sinha P , et al . Acute respiratory distress syndrome subphenotypes and differential response to simvastatin: Secondary analysis of a randomised controlled trial [J ] . Lancet Respir Med , 2018 , 6 ( 9 ): 691 ⁃ 698 .

Wei X B , Wang Z H , Liao X L , et al . Role of neuromuscular blocking agents in acute respiratory distress syndrome: An updated meta⁃analysis of randomized controlled trials [J ] . Front Pharmacol , 2020 , 10 : 1637 .

Papazian L , Forel J M , Gacouin A , et al . Neuromuscular blockers in early acute respiratory distress syndrome [J ] . N Engl J Med , 2010 , 363 ( 12 ): 1107 ⁃ 1116 .

National Heart L , Moss M , Huang D T , et al . Early neuromuscular blockade in the acute respiratory distress syndrome [J ] . N Engl J Med , 2019 , 380 ( 21 ): 1997 ⁃ 2008 .

Agarwal A , Hunt B , Stegemann M , et al . A living WHO guideline on drugs for COVID⁃19 [J ] . BMJ , 2020 , 370 : m3379 .

Dequin P F , Meziani F , Quenot J P , et al . Hydrocortisone in severe community⁃acquired pneumonia [J ] . N Engl J Med , 2023 , 388 ( 21 ): 1931 ⁃ 1941 .

Chang X Y , Li S J , Fu Y Q , et al . Safety and efficacy of corticosteroids in ARDS patients: A systematic review and meta⁃analysis of RCT data [J ] . Respir Res , 2022 , 23 ( 1 ): 301 .

Qadir N , Sahetya S , Munshi L , et al . An update on management of adult patients with acute respiratory distress syndrome: An official American thoracic society clinical practice guideline [J ] . Am J Respir Crit Care Med , 2024 , 209 ( 1 ): 24 ⁃ 36 .

Matthay M A , Calfee C S , Zhuo H J , et al . Treatment with allogeneic mesenchymal stromal cells for moderate to severe acute respiratory distress syndrome (START study): A randomised phase 2a safety trial [J ] . Lancet Respir Med , 2019 , 7 ( 2 ): 154 ⁃ 162 .

Wang F Y , Li Y M , Wang B Q , et al . The safety and efficacy of mesenchymal stromal cells in ARDS: A meta⁃analysis of randomized controlled trials [J ] . Crit Care , 2023 , 27 ( 1 ): 31 .

Hao Q , Gudapati V , Monsel A , et al . Mesenchymal stem cell⁃derived extracellular vesicles decrease lung injury in mice [J ] . J Immunol , 2019 , 203 ( 7 ): 1961 ⁃ 1972 .

Lv H J , Chen W J , Xiang A P , et al . Mesenchymal stromal cells as a salvage treatment for confirmed acute respiratory distress syndrome: Preliminary data from a single⁃arm study [J ] . Intensive Care Med , 2020 , 46 ( 10 ): 1944 ⁃ 1947 .

Liu J , Dean D A . Gene therapy for acute respiratory distress syndrome [J ] . Front Physiol , 2022 , 12 : 786255 .

Ware L B , Matthay M A . Alveolar fluid clearance is impaired in the majority of patients with acute lung injury and the acute respiratory distress syndrome [J ] . Am J Respir Crit Care Med , 2001 , 163 ( 6 ): 1376 ⁃ 1383 .

Adir Y , Welch L C , Dumasius V , et al . Overexpression of the Na⁃K⁃ATPase alpha2⁃subunit improves lung liquid clearance during ventilation⁃induced lung injury [J ] . Am J Physiol Lung Cell Mol Physiol , 2008 , 294 ( 6 ): L1233 ⁃L1237.

Soma T , Chiba H , Kato⁃Mori Y , et al . Thr(207) of claudin⁃5 is involved in size⁃selective loosening of the endothelial barrier by cyclic AMP [J ] . Exp Cell Res , 2004 , 300 ( 1 ): 202 ⁃ 212 .

Bowler R P , Nicks M , Tran K , et al . Extracellular superoxide dismutase attenuates lipopolysaccharide⁃induced neutrophilic inflammation [J ] . Am J Respir Cell Mol Biol , 2004 , 31 ( 4 ): 432 ⁃ 439 .

Buff S M , Yu H , McCall J N , et al . IL⁃10 delivery by AAV5 vector attenuates inflammation in mice with Pseudomonas pneumonia [J ] . Gene Ther , 2010 , 17 ( 5 ): 567 ⁃ 576 .

Calfee C S , Delucchi K , Parsons P E , et al . Subphenotypes in acute respiratory distress syndrome: Latent class analysis of data from two randomised controlled trials [J ] . Lancet Respir Med , 2014 , 2 ( 8 ): 611 ⁃ 620 .

Meyer E L , Mesenbrink P , Dunger⁃Baldauf C , et al . The evolution of master protocol clinical trial designs: A systematic literature review [J ] . Clin Ther , 2020 , 42 ( 7 ): 1330 ⁃ 1360 .

Coalition A P T . Adaptive platform trials: Definition, design, conduct and reporting considerations [J ] . Nat Rev Drug Discov , 2019 , 18 ( 10 ): 797 ⁃ 807 .

Berry S M , Connor J T , Lewis R J . The platform trial: An efficient strategy for evaluating multiple treatments [J ] . JAMA , 2015 , 313 ( 16 ): 1619 ⁃ 1620 .

ARDS数据库标准字段集共识(2022年版)专家组,中华医学会急诊医学分会,复旦大学附属中山医院 . ARDS数据库标准字段集专家共识(2022 年版) [J ] . 中华急诊医学杂志 , 2022 , 31 ( 8 ): 1010 ⁃ 1015 .

Expert Group of consensus on standard field set of ARDS database ( 2022 edition), Emergency Medicine Branch of Chinese Medical Association, Zhongshan Hospital Affiliated to Fudan University. Expert consensus on standard field set of ARDS database (2022 edition) [J ] . Chin J Emerg Med , 2022, 31 ( 8 ): 1010 ⁃ 1015 .

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