Multimodal phenotyping of ARDS: design and preliminary insights from the prospective BIOWARE cohort for precision critical management.

Summary

A prospective, multicenter ARDS cohort integrating clinical data, ventilator waveforms, multimodal imaging, and biospecimens established feasibility across nine centers. Early enrollment (n=169) achieved complete Day 1 biospecimen capture with some later-timepoint and specialized parameter constraints, setting a platform for mechanism-based endotyping and precision interventions.

Key Findings

• Prospective, multicenter design integrating clinical, ventilator waveform, CT, EIT, lung ultrasound, and biospecimen data for ARDS.
• Feasibility confirmed across nine centers with 169 patients enrolled and 100% Day 1 plasma and BALF collection.
• Follow-up biospecimen yields declined at later timepoints (e.g., Day 7 BALF n=24), and specialized parameters (e.g., P0.1) had higher missingness.
• Framework aims to identify mechanism-based ARDS endotypes to enable precision critical care.

Clinical Implications

Supports future stratified trials and bedside decision-making by linking physiological, imaging, and molecular profiles to outcomes, potentially guiding individualized PEEP, adjuncts, and pharmacotherapy in ARDS.

Limitations

• Preliminary sample size with incomplete later-timepoint sampling and missing specialized measures.
• Current report focuses on feasibility rather than validated endotypes or treatment-response links.

Future Directions

Complete enrollment, derive and externally validate biologically grounded ARDS endotypes, and test endotype-guided strategies in prospective interventional trials.