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Review
. 2024 Jan 5;13(2):317.
doi: 10.3390/jcm13020317.

Prone Positioning and Molecular Biomarkers in COVID and Non-COVID ARDS: A Narrative Review

Savino Spadaro  1   2 , Jose Daniel Jimenez-Santana  3 , Riccardo La Rosa  1   2 , Giorgia Spinazzola  4 , Pilar Argente Navarro  3 , Carlo Alberto Volta  1   2 , Gaetano Scaramuzzo  1   2
Affiliations
Review

Prone Positioning and Molecular Biomarkers in COVID and Non-COVID ARDS: A Narrative Review

Savino Spadaro et al. J Clin Med. .

Abstract

Prone positioning (PP) represents a therapeutic intervention with the proven capacity of ameliorating gas exchanges and ventilatory mechanics indicated in acute respiratory distress syndrome (ARDS). When PP is selectively applied to moderate-severe cases of ARDS, it sensitively affects clinical outcomes, including mortality. After the COVID-19 outbreak, clinical application of PP peaked worldwide and was applied in 60% of treated cases, according to large reports. Research on this topic has revealed many physiological underpinnings of PP, focusing on regional ventilation redistribution and the reduction of parenchymal stress and strain. However, there is a lack of evidence on biomarkers behavior in different phases and phenotypes of ARDS. Patients response to PP are, to date, decided on PaO2/FiO2 ratio improvement, whereas scarce data exist on biomarker tracking during PP. The purpose of this review is to explore current evidence on the clinical relevance of biomarkers in the setting of moderate-severe ARDS of different etiologies (i.e., COVID and non-COVID-related ARDS). Moreover, this review focuses on how PP may modulate biomarkers and which biomarkers may have a role in outcome prediction in ARDS patients.

Keywords: ARDS; COVID-19; biomarkers; prone position.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Changes in V/Q ratio after initiation of PP in mechanically ventilated patients with ARDS. Redistribution of ventilation more homogeneously helps the overall reduction of V/Q mismatch. See the text for details.
Figure 2
Figure 2
Effects of the prone position on recruitment and ventilation distribution in a patient with C-ARDS. Inhomogeneity of dorsal regions appears reduced after shift to PP, whereas ventral regions appear less recruited, possibly by means of reduced overdistention. Adapted from Fossali T. et al. [41].
Figure 3
Figure 3
A schematic figure of clinically relevant biomarkers in supine and prone positions during ARDS. See the text for details.
See this image and copyright information in PMC

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