Objective:

To synthesize evidence on the role of viral and fungal infections in nonresolving acute respiratory distress syndrome (ARDS).

Key Findings:

• Invasive pulmonary aspergillosis is common in ARDS secondary to severe viral pneumonia, with mortality rates exceeding 50%, highlighting the severity of this complication.

Interpretation:

The interplay between viral and fungal infections in ARDS underscores the urgent need for improved diagnostic and treatment strategies to effectively manage these complications.

Limitations:

• Biases in observational studies and limited sample sizes in clinical trials may affect the reliability of the findings.

Conclusion:

Systematic assessment of viral reactivation in ARDS patients may be warranted, given the potential for significant clinical impact despite uncertainties in treatment efficacy.