The Microbiome in Acute Lung Injury and ARDS

The acute respiratory distress syndrome (ARDS) is a heterogeneous clinical entity of severe respiratory failure, which develops in response to various inflammatory insults and pathogenetic mechanisms. Clinical and biologic heterogeneity in ARDS has hampered the discovery of targeted and efficacious therapies, and clinical care has remained largely supportive. However, the established causal model of ARDS (i.e., an injurious exposure causing inflammatory lung damage) has not considered a potentially central determinant of pathogenesis: the microbiome. Accumulating evidence suggests that lung microbial communities are significantly altered in patients with ARDS, with dysbiosis accounting for variability in host inflammatory responses and clinical outcomes. In this chapter, we synthesize the ecological models, epidemiologic evidence from human studies, and experimental data from animal models to understand the role of the lung and gut microbiome in ARDS and outline research priorities for clinical translation of microbiome research to innovative care for ARDS.KeywordsAcute respiratory distress syndromeAcute lung injuryMicrobiomeMicrobiotaDysbiosisNext-generation sequencingMetagenomics