ARDS

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Adult Respiratory Distress Syndrome: Adult respiratory distress syndrome (ARDS) is a severe lung condition. It occurs when fluid fills up the air sacs in your lungs. Too much fluid in your lungs lowers the amount of oxygen in your bloodstream. With ARDS, your organs may not have enough oxygen to function.
ARDS most commonly affects hospitalized patients who are very ill. It can also be caused by serious trauma. Symptoms usually occur within a day or two of the original illness. These may include extreme shortness of breath and gasping for air.
ARDS is a serious medical condition. Many people with ARDS do not survive.

Causes: ARDS is primarily caused by damage to tiny blood vessels in your lungs. Fluid from these tiny vessels leaks into the air sacs in your lungs. These air sacs are where your blood is oxygenated. When these air sacs fill with fluid, less oxygen gets to your blood.

Some common things that may lead to this type of lung damage include:
  • Inhaling toxic substances, such as salt water, chemicals, smoke, and vomit
  • Developing a severe blood infection
  • Developing a severe infection of the lungs, such as pneumonia
  • Receiving an injury to the chest or head, such as during a car wreck or contact sports
  • Overdosing on sedatives or tricyclic antidepressants.

Risk Factors: Risk factors for ARDS include being over 65 years old, smoking cigarettes, chronic lung disease, and a history of alcoholism.

Certain people are more likely to die of ARDS. These include those who:
  • Have toxic shock
  • Are of older chronological age
  • Suffer from liver failure
  • Have a history of alcoholism.
Sex and race may also play a role in mortality. Men are more likely to die of ARDS than women. African Americans have a higher ARDS death rate than people of other races.

Symptoms:

Symptoms of ARDS typically appear between one to three days after the injury or trauma.
Common symptoms of ARDS include:
  • Labored and rapid breathing
  • Muscle fatigue and general weakness
  • Low blood pressure
  • Discolored skin or nails
  • Dry hacking cough
  • Fever
  • Headaches
  • Fast pulse rate
  • Mental confusion

Diagnosing: If you suspect that someone you know has ARDS, please get medical assistance immediately. Early diagnosis may help them survive the condition. ARDS is a medical emergency.

ARDS is diagnosed by a physician in several different ways. There is no one definitive test for diagnosing this condition. The treating physician may conduct a physical exam along with the following tests:
  • Blood pressure
  • Blood test
  • Chest X-ray
  • Computed tomography (CT) scan
  • Throat and nose swabs
  • Electrocardiogram
  • Echocardiogram
  • Airway examination
Low blood pressure and low blood oxygen can make a doctor suspect ARDS. An electrocardiogram and echocardiogram may be used to rule out a heart condition. If a chest X-ray or CT scan then reveals fluid-filled air sacs in the lungs, a diagnosis for ARDS is confirmed. A lung biopsy can also be conducted to confirm an ARDS diagnosis.

Treatment: The primary goal of ARDS treatment is to give you enough oxygen to prevent organ failure. Your physician may give you oxygen by mask. A mechanical ventilation machine can also be used to force air into your lungs and reduce the fluid in the air sacs.

Physicians may implement a supportive breathing method known as positive end-expiratory pressure (PEEP). PEEP helps control the pressure in the lungs. High PEEP may help increase lung functioning and decrease lung injury related to using a ventilator.
Management of fluid intake is another ARDS treatment strategy. This can help ensure an adequate fluid balance. Too much fluid in the body can lead to build up in the lungs. However, too little fluid can cause the organs and heart to become strained.
Individuals with ARDS are often given medication to deal with side effects. Pain medication can relieve discomfort. Antibiotics or corticosteroids can treat an infection. Blood thinners can be used to keep clots from forming in the lungs or legs.
Pulmonary rehabilitation may be needed by people recovering from ARDS. This is a way to strengthen the respiratory system and increase lung capacity. Such programs can include exercise training, classroom teaching, and support teams to help you recover from ARDS.

Prognosis: Unfortunately, around 40 percent of people with ARDS die of organ failure. However, the risk of death is not the same for all ARDS patients. Death rate is linked to both the cause of ARDS and the patient’s overall health. For example, a young patient with trauma-induced ARDS will have a better prognosis than an older patient with a widespread blood infection. The prognosis becomes evident within the first 10 days of treatment for about half of all patients with ARDS.

Many survivors of ARDS will full recover within a few months. However, some people may experience life-long lung damage. Other side effects may include muscle weakness, fatigue, impaired quality of life, and compromised mental health.

Preventing: There is no way to completely prevent ARDS. However, the following suggestions may help lower your risk.

  • Seek prompt medical assistance for any trauma, infection, or illness.
  • Stop smoking cigarettes, and stay away from secondhand smoke.
  • Give up alcohol. Chronic alcohol use may increase your mortality risk and prevent proper lung function.
  • Get your flu vaccine annually and pneumonia vaccine every five years. This decreases your risk of lung infections.

Complications: Since ARDS is an extremely serious condition which requires invasive forms of therapy it is not without risk. Complications to be considered are:


  • Pulmonary: barotrauma (volutrauma), pulmonary embolism (PE), pulmonary fibrosis, ventilator-associated pneumonia (VAP)
  • Gastrointestinal: hemorrhage (ulcer), dysmotility, pneumoperitoneum, bacterial translocation
  • Cardiac: arrhythmias, myocardial dysfunction
  • Renal: acute renal failure (ARF), positive fluid balance
  • Mechanical: vascular injury, pneumothorax (by placing pulmonary artery catheter), tracheal injury/stenosis (result of intubation and/or irritation by endotracheal tube
  • Nutritional: malnutrition (catabolic state), electrolyte deficiency. 

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