Identifying clinical research priorities in adult pulmonary and critical care: NHLBI working group report

Matthew W. Semler, Gordon R. Bernard, Shawn D. Aaron, Derek C. Angus, Michelle H. Biros, Roy G. Brower, Carolyn S. Calfee, Elizabeth A. Colantuoni, Niall D. Ferguson, Michelle N. Gong, Ramona O. Hopkins, Catherine L. Hough, Theodore J. Iwashyna, Bruce D. Levy, Thomas R. Martin, Michael A. Matthay, Joseph P. Mizgerd, Marc Moss, Dale M. Needham, Wesley H. SelfChristopher W. Seymour, Renee D. Stapleton, B. Taylor Thompson, Richard G. Wunderink, Neil R. Aggarwal, Lora A. Reineck

Research output: Contribution to journalArticlepeer-review

Abstract

Preventing, treating, and promoting recovery from critical illness due to pulmonary disease are foundational goals of the critical care community and the NHLBI. 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 preclinical 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, preclinical disease modeling, and understanding of recovery fromacute illness promise to transformthemethods of pulmonary and critical care clinical research. To assess the current state of, research priorities for, and future directions in 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 preclinical models by incorporating comorbidities, cointerventions, and organ support; 3) developing and applying novel clinical trial designs; and 4) advancing mechanistic understanding of injury and recovery 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.

Original languageEnglish (US)
Pages (from-to)511-523
Number of pages13
JournalAmerican journal of respiratory and critical care medicine
Volume202
Issue number4
DOIs
StatePublished - Aug 15 2020

Bibliographical note

Funding Information:
Supported in part by the National Institute for General Medical Sciences (grants P01GM095467 [B.D.L.] and R35GM119519 [C.W.S.]), the NHLBI (grants R35HL140026 [C.S.C.], R24HL111895 [D.M.N.], R35HL135756 and R33HL137081 [J.P.M.], U01HL123004 and R42HL126456 [M.A.M.], K24HL089223 [M.M.], K23HL143053 [M.W.S.], R01HL132887 [R.D.S.], and K12HL138039 [T.J.I.]), the National Institute of Allergy and Infectious Diseases (grants R01AI115053 [J.P.M.] and U19AI135964 [R.G.W.]), the National Center for Complementary and Integrative Health (grant R34AT009181 [M.M.]), the American Thoracic Society (M.M.), the National Institute on Aging (grant R01AG050698 [R.D.S.]), the Intermountain Research and Medical Foundation (R.O.H.), and the Veterans Health Administration (grant I01HX002390 [T.J.I.]). The content of this manuscript is the responsibility of the authors alone and does not necessarily reflect the views or policies of the U.S. Department of Veterans Affairs, the U.S. Department of Health and Human Services, or the U.S. government.

Publisher Copyright:
© 2020 by the American Thoracic Society.

Keywords

  • Acute respiratory failure
  • Clinical trials
  • Mechanical ventilation
  • Pneumonia
  • Sepsis

PubMed: MeSH publication types

  • Journal Article

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