The ten studies that should be done in ARDS

Acute respiratory distress syndrome (ARDS) is arguably the archetypal disease of intensive care medicine. In choosing ten studies that should be done we have asked what important questions might be capable of being answered by clinical trials, accepting that further preclinical research may be needed first. Of course exciting studies in other areas such as prone positioning and extracorporeal assistance are underway or being reported. Perhaps the tipping point for the clinical uptake of lung protective ventilation was the ARDS Network ARMA trial [1] which found that lower tidal volumes reduced mortality, despite initially worse oxygenation reinforcing the need for a conservative approach to surrogate outcomes. However, the association of survival with lower levels of systemic inflammation emphasises the importance of lung inflammation and repair. Some of the research questions we propose build on these important contributions, asking more precise questions, and assume that the patients are receiving protective ventilation.