ARDS management in trauma patients

Abstract: Acute respiratory distress syndrome (ARDS) is a frequent and severe complication in trauma patients, arising from a complex interplay between direct tissue injury, systemic inflammation, and resuscitation-related factors. Although trauma accounts for a minority of ARDS cases overall, its incidence remains high in patients with severe thoracic injury. The pathophysiology is best described by a “multi-hit” model, in which the initial traumatic insult is followed by a dysregulated inflammatory response and additional secondary insults, including transfusion, infection, or fat embolism, ultimately leading to alveolar-capillary barrier disruption and respiratory failure. Early identification of patients at risk is crucial and relies on clinical severity scores and multimodal imaging. Thoracic imaging, including chest X-ray, lung ultrasound, and computed tomography, plays a central role in diagnosis, monitoring, and risk stratification. Management is largely supportive and based on lung-protective ventilation strategies, with careful integration of non-invasive respiratory support in selected patients. Pain control, hemodynamic optimization, and timely surgical interventions are key components of care, as they directly influence respiratory mechanics and may prevent progression to ARDS. Special clinical scenarios, including traumatic brain injury and hypothermia, require individualized approaches due to complex brain-lung and systemic interactions. Overall, a multidisciplinary, physiology-driven strategy is essential to optimize outcomes in trauma-related ARDS. Visual abstract: (Figure presented.)