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Am J Respir Crit Care Med. 2020 Mar 9. doi: 10.1164/rccm.201908-1595WS. [Epub ahead of print]

Identifying Clinical Research Priorities in Adult Pulmonary and Critical Care: NHLBI Working Group Report.

Author information

1
Vanderbilt University Medical Center, 12328, Department of Allergy, Pulmonary, and Critical Care Medicine, Nashville, Tennessee, United States.
2
Ottawa Health Research Institute, Ottawa, Ontario, Canada.
3
University of Pittsburgh, Pittsburgh, Pennsylvania, United States.
4
University of Minnesota, 5635, Department of Emergency Medicine, Minneapolis, Minnesota, United States.
5
School of Medicine, Johns Hopkins University, Pulmonary and Critical Care, Baltimore, Maryland, United States.
6
UCSF, Medicine, San Francisco, California, United States.
7
Johns Hopkins University, Biostatistics, Baltimore, Maryland, United States.
8
University Health Network, Department of Medicine, Division of Respirology, Toronto, Ontario, Canada.
9
University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada.
10
Montefiore Medical Center, Division of Critical Care Med, Bronx, New York, United States.
11
Brigham Young University, Psychology, Provo, Utah, United States.
12
Intermountain Medical Center, Critical Care Medicine, Murray, Utah, United States.
13
University of Washington, Pulmonary and Critical Care Medicine, Seattle, Washington, United States.
14
University of Michigan, Division of Pulmonary and Critical Care Medicine, Ann Arbor, Michigan, United States.
15
Brigham and Women's Hospital Biomedical Research Institute, 278479, Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States.
16
University of Washington, 7284, Medicine, Seattle, Washington, United States.
17
Cardiovascular Research Institute (CVRI), University of San Francisco, Medicine and Anesthesia, San Francisco, California, United States.
18
BU School of Medicine, Pulmonary Center, Boston, Massachusetts, United States.
19
University of Colorado/ Emory University, Division of Pulmonary Sciences and Critical Care Medicine, Denver, Colorado, United States.
20
Johns Hopkins University, Pulmonary & Critical Care Medicine, Baltimore, Maryland, United States.
21
Vanderbilt University Medical Center, 12328, Department of Emergency Medicine, Nashville, Tennessee, United States.
22
University of Vermont College of Medicine, 12352, Division of Pulmonary Disease and Critical Care Medicine, Burlington, Vermont, United States.
23
Massachusetts General Hospital, Harvard School of Medicine,, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston, Massachusetts, United States.
24
Northwestern University, Chicago, Illinois, United States.
25
National Heart Lung and Blood Institute Division of Lung Diseases, 377197, Bethesda, Maryland, United States.
26
NHLBI, 35035, Division of Lung Diseases, Bethesda, Maryland, United States; lora.reineck@nih.gov.

Abstract

Preventing, treating, and promoting recovery from critical illness due to pulmonary disease are foundational goals of the critical care community and the National Heart, Lung, and Blood Institute. Decades of clinical research in acute respiratory distress syndrome, acute respiratory failure, pneumonia, and sepsis have yielded improvements in supportive care, which have translated into improved patient outcomes. Novel therapeutics have largely failed to translate from promising pre-clinical findings into improved patient outcomes in late-phase clinical trials. Recent advances in personalized medicine, "big data", causal inference using observational data, novel clinical trial designs, pre-clinical disease modeling, and understanding recovery from acute illness promise to transform the methods of pulmonary and critical care clinical research. To assess the current state, research priorities, and future directions for adult pulmonary and critical care research, the NHLBI assembled a multidisciplinary working group of investigators. This working group identified recommendations for future research, including: (1) focusing on understanding the clinical, physiological, and biological underpinnings of heterogeneity in syndromes, diseases, and treatment-response with the goal of developing targeted, personalized interventions; (2) optimizing pre-clinical models by incorporating comorbidities, co-interventions, and organ support; (3) developing and applying novel clinical trial designs; and (4) advancing mechanistic understanding of injury and recovery in order to develop and test interventions targeted at achieving long-term improvements in the lives of patients and families. Specific areas of research are highlighted as especially promising for making advances in pneumonia, acute hypoxemic respiratory failure, and acute respiratory distress syndrome.

KEYWORDS:

acute respiratory failure; clinical trials; mechanical ventilation; pneumonia; sepsis

PMID:
32150460
DOI:
10.1164/rccm.201908-1595WS

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