A retrospective cohort study of 1,716 ARDS patients from the West China Hospital Big Data Platform (2012–2025) investigated the effect of four nursing interventions—airway suctioning, prone positioning, oral care, and enteral nutrition (EEN)—on the physiological trajectories of SpO₂, CRP, lactate, and creatinine. Using latent class mixed-effects models, three distinct trajectories were identified for each biomarker, relating to oxygenation, inflammation, metabolism and renal function. Early prone positioning within 24 hours was associated with lower odds of an adverse SpO₂ trajectory (OR 0.08, 95% CI 0.01–0.59) and a high CRP trajectory (OR 0.18, 95% CI 0.06–0.59). Delayed positioning at 72 hours increased the odds of a persistently low lactate trajectory (OR 5.17, 95% CI 1.21–22.06) and a U-shaped lactate trajectory (OR 5.07, 95% CI 2.07–12.4). EEN reduced the likelihood of high CRP trajectories (OR 0.31–0.45). Airway suctioning promoted favorable oxygenation trajectories, oral care was more common in unstable oxygenation, with unstable oxygenation trajectories having higher 28-day mortality. Early and standardized interventions, particularly prone positioning and EEN, were associated with more favorable recovery profiles.