A mini-review of the relationship between intestinal microecology and acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS), a critical condition with high mortality, arises from dysregulated inflammation and lung injury. While evidence-based supportive care remains foundational, the lack of effective targeted therapies underscores the need for novel approaches. This review focuses on the emerging role of intestinal microecology in ARDS pathogenesis via the gut-lung axis. We discuss how ARDS disrupts gut barrier integrity, promotes dysbiosis and bacterial translocation, and highlight the significance of some gut microbiota-derived metabolites in modulating pulmonary immunity and inflammation. Furthermore, we explore how intestinal microecology influences ARDS progression through mechanisms like oxidative stress, apoptosis, autophagy, and pyroptosis. The review also examines the potential of microecology-based interventions and draws insights from failed immunomodulatory trials, emphasizing the critical interplay between the microbiome and host immunity. By synthesizing these links, this review identifies the gut microbiota as a source of potential early-warning biomarkers and novel therapeutic targets, aiming to inform future strategies for managing ARDS in the intensive care unit (ICU).