In critically ill patients, lung and gut microbiomes undergo profound changes. Lung microbiome might become enriched with gut-associated microbes as recently demonstrated in sepsis and acute respiratory distress syndrome (ARDS). It has been proposed that in these conditions, bacteria from the gut might enter the lungs via translocation, a process facilitated by increased gut and alveolo-capillary permeability. In patients requiring mechanical ventilation after severe trauma, lung microbiome enrichment with gut-associated microbes was found to correlate with the development of ARDS. The lungs in ARDS are increasingly susceptible to opportunistic infections which can further perpetuate alveolar inflammation and injury. Undoubtedly, more research on the gut-lung crosstalk in critically ill patients is needed to identify causal relationships between the altered microbiome, infections, inflammation, and acute lung injury. With further insights, this area of investigation could lead to the development of novel, microbiome-targeted, and immunomodulation strategies with the potential to improve outcomes of critically ill patients with sepsis, trauma, and ARDS
