Case Report

Managing Refractory Hypoxemia in Trauma-Induced ARDS Complicated by Right Hemothorax: The Role of Inverse Ratio Ventilation

Abstract

Trauma-associated acute respiratory distress syndrome (ARDS) with refractory hypoxemia remains difficult to manage, especially when conventional lung-protective ventilation fails. Inverse ratio ventilation (IRV) may improve oxygenation by increasing mean airway pressure and alveolar recruitment. A patient with spinal cord injury and massive hemothorax developed severe hypoxemia and low lung compliance despite conventional mechanical ventilation. Ventilation was escalated to pressure-controlled ventilation with prolonged inspiratory time, higher PEEP, deep sedation, and IRV-oriented settings. Oxygenation and lung compliance improved progressively without significant hemodynamic instability or ventilator-related complications. Prone positioning was not feasible because of spinal trauma. IRV-oriented ventilation may serve as an effective rescue strategy in trauma-induced ARDS with refractory hypoxemia when standard lung-protective ventilation is insufficient. Careful titration and monitoring are essential to optimize oxygenation while minimizing complications.

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Keywords
Acute Respiratory Distress Syndrome Inverse Ratio Ventilation Refractory Hypoxemia Trauma Hemothorax Mechanical Ventilation
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How to Cite
1.
Mahesa R, Semedi B, Rahmasena N, Gibran D. Managing Refractory Hypoxemia in Trauma-Induced ARDS Complicated by Right Hemothorax: The Role of Inverse Ratio Ventilation. Arch Anesth & Crit Care. 2026;.