From oxygenation to omics: biomarkers as windows into pathophysiology and tools for prognostic and predictive enrichment in PARDS

In the article, “Unraveling Mortality Risk in Pediatric Acute Respiratory Distress Syndrome: Key Biomarkers and Pathophysiological Insights”, Nimmankiatkul et al. impressively reviewed and contextualized many of the biomarkers with roles in mortality prognostication in PARDS. 1 Based on this work, what are some important takeaway messages and next steps to be considered related to the use of biomarkers in PARDS? Three important considerations include: 1) understanding the evolution of ARDS definitions and translational work over the last 50 years since ARDS was first described, 2) further exploration into the host responses to critical illness over time, and their roles in identifying biomarkers that can afford prognostic and predictive enrichment strategies for future trial design and bedside cares, and 3) reevaluating the relevance of mortality as a major outcome for ARDS related studies.