Acute respiratory distress syndrome in active duty service members: Rare and lethal

Abstract: INTRODUCTION: Acute respiratory distress syndrome (ARDS) is associated with significant mortality and long-term morbidity, often preventing survivors from returning to work. This poses particular challenges in the military, where maintaining combat-ready forces depends on the health and readiness of service members. This study investigates ARDS in active duty U.S. military personnel to estimate its broader impact on the military. MATERIALS AND METHODS: A retrospective cohort study was conducted with Institutional Review Board (IRB) approval, utilizing the U.S. Military Data Repository, which contains health data from all active duty service members. Acute respiratory distress syndrome was identified using Current Procedural Terminology (CPT) codes and confirmed with chart review. Data were collected on demographics, clinical course, underlying ARDS etiology, survival, and military separation. Statistical analyses included univariate comparisons to identify demographic and clinical factors associated with mortality. RESULTS: The overall incidence of ARDS in active duty personnel was 1.01 per 100,000 person-years, with a 2-fold increase in the post-COVID period (1.55 per 100,000 person-years) compared to the pre-COVID period (0.76 per 100,000 person-years). The most common cause of ARDS was infection (53%), followed by trauma (16%). The mean age of affected servicemembers was 32 years, with a mortality rate of 20%. Among those who survived, 43% failed to return to active duty and were medically separated; 70% of these separations were directly attributable to ARDS or related complications, while 30% were because of other etiologies. CONCLUSIONS: Acute respiratory distress syndrome poses significant risks to active duty military personnel, with notable short-term mortality and long-term morbidity, including high rates of medical separation and failure to return to duty. These complications could impact the military overall by decreasing the workforce, impairing military readiness, and introducing financial burdens. Further studies are needed to fully assess functional limitations following ARDS and to optimize management strategies that enhance recovery outcomes for military service members affected by the condition.