PhD defence P.A. (Philip) van der Zee

Below is a brief summary of the dissertation:

Despite more than 50 years of clinical research in patients with Acute Respiratory Distress Syndrome (ARDS), only few interventions have shown to significantly improve clinical outcomes. The heterogeneity in risk factor for ARDS, inflammatory status, and respiratory mechanics likely resulted in no overall treatment effect in trials including patients with ARDS. However, secondary analyses of negative randomized controlled trials found that some subgroups of patients did benefit from a significant treatment effect. In this thesis, we aimed to personalise treatment of patients with ARDS based on biomarkers or recruitability. 

In part 1. we identified biomarkers that are associated with development of ARDS and ARDS mortality. Subsequently, we identified a subset of patients with community acquired pneumonia that does seem to benefit from adjuvant treatment with corticosteroids. Eventually, our objective is to confirm these results in a randomized controlled trial.

In part 2. we used advanced respiratory monitoring techniques in order to assess recruitability. Recruitability is the amount of collapsed lung tissue that has the potential for reaeration. The assessment of recruitability using electrical impedance tomography predicts the response to a change in positive end-expiratory pressure.

Both biomarkers and recruitability can be used in future randomized trials to personalise treatment of patients with ARDS. In addition, instead of predicting response to treatment, we could assess response to treatment and change treatment accordingly, i.e. response based personalised treatment.