Acute respiratory distress syndrome in trauma patients—Treatment interventions and risks

Acute Respiratory Distress Syndrome (ARDS) remains a major cause of morbidity and mortality in trauma patients, rising from a complex interplay of direct lung injury, systemic inflammation, transfusion and mechanical ventilation-related factors. Optimal management requires a multifaceted approach that balances lung-protective ventilation strategies, hemodynamic stability and supportive interventions. Positive end-expiratory pressure (PEEP) and prone positioning improve alveolar recruitment, ventilation homogeneity and oxygenation, moderating ventilator-induced lung injury (VILI). Extracorporeal membrane oxygenation (ECMO), particularly veno-venous ECMO, provides a rescue strategy in refractory hypoxemia but carries significant bleeding risks in multi-trauma patients due to necessary anticoagulation. Fluid management remains critical: both overload and excessive restriction can exacerbate pulmonary compromise or hemodynamic instability. Transfusion practices, including the timing and volume of blood products, significantly influence ARDS development, with blunt thoracic trauma, emergent surgery and high BMI identified as independent risk factors. Despite the progress that has been made, the heterogeneity of ARDS pathophysiology and patient's specific variables necessitate individualized, multidisciplinary management to optimize outcomes in critically ill, trauma patients.