Table 3.

Areas for Future Prospective Research

1. Conduct large multicenter studies (similar to LUNG SAFE) (27) to determine how often patients treated with HFNO or NIV advance to requiring intubation and mechanical ventilation, including outcomes such as mortality for patients in each of these categories

2. Assess the prognostic value and clinical implications of unilateral vs. bilateral opacities on chest radiography

3. Identify the limitations to operationalization of the new ARDS definition (e.g., how often pulse oximetry was not accurate for quantifying hypoxemia because of shock or skin pigmentation)

4. Carry out research (e.g., in resource-limited areas) to determine the incidence of ARDS diagnosis in the absence of any oxygen therapy (room air) compared with subjects treated with supplemental oxygen and the associated outcomes, specifically mortality

5. Evaluate prognostic and clinical utility (e.g., whether the oxygenation severity categories have prognostic value in nonintubated patients)

6. Evaluate the specificity of lung ultrasound diagnosis of ARDS among different operators in diverse clinical settings using different acquisition/interpretation protocols

7. Determine the relationship of biological categories of ARDS, such as hyper- and hypo-inflammatory subphenotypes, in the new global definition of ARDS and assess these biological categories in the context of sepsis and pneumonia

8. Prospectively evaluate this new global definition of ARDS on the basis of large clinical trials and observational studies around the world, including evaluation of how the new definition affects estimates of ARDS incidence

9. Evaluate the long-term outcomes of patients with diagnoses of ARDS using the new global definition of ARDS in prospective epidemiological studies

Definition of abbreviations: ARDS = acute respiratory distress syndrome; HFNO = high-flow nasal oxygen; LUNG SAFE = Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure; NIV = noninvasive ventilation.