In this forward-looking episode of the SCCM Podcast, Daniel F. McAuley, MD, explores how the clinical and research communities are rethinking acute respiratory distress syndrome (ARDS), shifting from a one-size-fits-all model to a focus on identifying and targeting modifiable traits. Building on his Thought Leader Session at the 2024 Critical Care Congress, Dr. McAuley unpacks the major thematic shift toward precision medicine in critical care.

Instead of treating ARDS as a single, homogenous condition, researchers are increasingly identifying biologically distinct subgroups—especially hyper- and hypoinflammatory phenotypes—that may respond differently to therapies. These insights are fueling a new generation of trials that aim to prospectively apply this knowledge to treatment strategies.

Central to this evolution is the Precision medicine Adaptive platform Network Trial in Hypoaemic acutE respiratory failure (PANTHER), of which Dr. McAuley is a team member. PANTHER is a Bayesian adaptive platform randomized clinical trial studying novel interventions to improve outcomes for patients with acute hypoxemic respiratory failure. Designed to be adaptive and biomarker informed, PANTHER will test therapies such as simvastatin and baricitinib, based on real-time phenotyping of patients with ARDS.

Throughout the episode, Dr. McAuley reflects on how advances in machine learning and biomarker identification are making precision treatment more feasible. He discusses the importance of maintaining evidence-based supportive care, such as lung-protective ventilation and prone positioning, while integrating new targeted therapies. Discover the latest investigations into potential therapeutic agents—including mesenchymal stromal cells, statins, and extracorporeal carbon dioxide removal—as Dr. McAuley aims to translate early findings into tangible improvements in patient outcomes.

This episode offers critical insights into the changing landscape of ARDS research and patient care, as Dr. McAuley articulates a hopeful vision for the future—one in which targeted, individualized treatments can improve outcomes for patients with one of critical care’s most challenging conditions.

Dr. McAuley is a consultant and professor in intensive care medicine in the regional intensive care unit at the Royal Victoria Hospital and Queen’s University of Belfast. He is program director for the  Medical Research Council/National Institute for Health and Care Research (MRC/NIHR) Efficacy and Mechanism Evaluation Program and scientific director for programs in NIHR.