Understanding clinical and biological heterogeneity to advance precision medicine in paediatric acute respiratory distress syndrome

Martin C.J. Kneyber, Robinder G. Khemani, Anoopindar Bhalla, Robert G.T. Blokpoel, Pablo Cruces, Mary K. Dahmer, Guillaume Emeriaud, Jocelyn Grunwell, Stavroula Ilia, Bhushan H. Katira, Yolanda M. Lopez-Fernandez, Prakadeshwari Rajapreyar, L. Nelson Sanchez-Pinto, Peter C. Rimensberger

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)


Paediatric acute respiratory distress syndrome (PARDS) is a heterogeneous clinical syndrome that is associated with high rates of mortality and long-term morbidity. Factors that distinguish PARDS from adult acute respiratory distress syndrome (ARDS) include changes in developmental stage and lung maturation with age, precipitating factors, and comorbidities. No specific treatment is available for PARDS and management is largely supportive, but methods to identify patients who would benefit from specific ventilation strategies or ancillary treatments, such as prone positioning, are needed. Understanding of the clinical and biological heterogeneity of PARDS, and of differences in clinical features and clinical course, pathobiology, response to treatment, and outcomes between PARDS and adult ARDS, will be key to the development of novel preventive and therapeutic strategies and a precision medicine approach to care. Studies in which clinical, biomarker, and transcriptomic data, as well as informatics, are used to unpack the biological and phenotypic heterogeneity of PARDS, and implementation of methods to better identify patients with PARDS, including methods to rapidly identify subphenotypes and endotypes at the point of care, will drive progress on the path to precision medicine.

Original languageEnglish
Pages (from-to)197-212
Number of pages16
JournalThe Lancet. Respiratory medicine
Issue number2
Publication statusPublished - 1 Feb 2023


  • Biomarkers
  • Child
  • Humans
  • Lung
  • Precision Medicine
  • Respiratory Distress Syndrome/therapy


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