Mechanical Ventilation in Trauma-Induced Respiratory Failure: A Clinical Review

Trauma is a leading cause of mortality in young adults, with thoracic injuries playing a central role in respiratory failure and ARDS. Pulmonary contusion is the principal risk factor, although extra-thoracic injuries—including traumatic brain injury, abdominal trauma, and long bone fractures—further increase ARDS incidence and complicate management. Early application of damage control strategies, including judicious fluid resuscitation and balanced blood product transfusion, can mitigate these risks. This review examines principles of mechanical ventilation in trauma-induced ARDS, with emphasis on protective ventilation strategies. Yet, trauma-specific contexts—such as persistent air leaks, flail chest, abdominal hypertension, and intracranial hypertension—require tailored adaptations. Prone positioning improves oxygenation in severe hypoxemia, though data in trauma are limited. Alternative ventilation modes and extracorporeal membrane oxygenation (ECMO) represent a rescue therapy in refractory cases; veno-venous ECMO offers feasible survival benefits despite bleeding concerns, whereas veno-arterial ECMO is associated with poorer outcomes. Ultimately, management of trauma-related respiratory failure requires a personalized approach, balancing conventional and advanced ventilatory strategies to optimize outcomes.