What is it about?
We developed a mathematical model to predict the effect of extracorporeal carbon dioxide removal on driving pressure in patients with ARDS based on foundational principles in respiratory physiology. We illustrate how this model can be used to select patients for CO2 removal, and how this approach can enhance statistical power to detect treatment effects and impact trial design.
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Why is it important?
Precision medicine is a much-discussed ideal that has yet to substantially impact clinical practice or clinical research in critical care medicine. The approach we develop can be immediately applied in future trials of extracorporeal CO2 removal using readily available clinical physiological measurements, enabling the application of the precision medicine paradigm in acute respiratory failure.
Perspectives
While precision medicine discussions generally center on advances in molecular biology and biochemistry, our approach highlights the continued value of clinical physiology as a sound basis for tailoring therapy to individual patients. The science of physiology is the cornerstone of clinical practice in intensive care medicine and continued advances in our field will continue to depend on advances in physiology and applications of physiology.
Ewan Goligher
University of Toronto
Read the Original
This page is a summary of: Applying Precision Medicine to Trial Design Using Physiology. Extracorporeal CO2 Removal for Acute Respiratory Distress Syndrome, American Review of Respiratory Disease, September 2017, American Thoracic Society,
DOI: 10.1164/rccm.201701-0248cp.
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