Impact of a Global Pandemic on Acute Respiratory Distress Syndrome in Trauma Patients

The COVID-19 pandemic has heightened clinical awareness of Acute Respiratory Distress Syndrome (ARDS), particularly in non-trauma patients. However, its impact on trauma patients remains unclear. Additionally, the strain on healthcare systems during the pandemic may have influenced the mortality risk in trauma patients with ARDS. Therefore, we hypothesized that the rate of ARDS in trauma patients would rise during the pandemic and that trauma patients with ARDS would experience an increased risk of mortality due to the pandemic's impact on healthcare systems. The Trauma Quality Improvement Program was queried for severely injured patients hospitalized >2 days. Patients were grouped into pre-COVID (2017-2019) and COVID (2021-2022) cohorts, with bivariate and multivariable logistic regression analyses performed. Of 628,465 patients, 281,250 (44.8%) presented during COVID years. The ARDS rate (1.0 vs. 1.3%, p <0.001) and risk (OR 0.74, CI 0.71-0.78, p <0.001) decreased during COVID years. In an ARDS-only subgroup, the mortality rate (37.4 vs. 29.3%, p <0.001) and associated risk (OR 1.45, CI 1.31-1.62, p <0.001) increased during COVID years. Although the rate of ARDS increased among non-trauma patients during the pandemic, contrary to clinical expectation it appeared to decrease in the trauma population. Fundamental differences in ARDS pathophysiology or evolving respiratory care practices during the pandemic may have contributed to this observed decrease in ARDS. Despite this decrease, the associated risk of mortality among trauma patients sustaining ARDS during the pandemic increased, which may be due to overwhelmed healthcare systems and resource strain, which merits future research.Level of Evidence: IV.