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ARDS Acute Respiratory Distress Syndrome Overview
Acute respiratory distress syndrome or ARDS is a severe and life threatening condition of the lungs that causes the lungs to fill with fluid and become poor at air exchange. Oxygen transport is compromised and it cannot get into the lungs because of the lung fluid excess. It is related to infant respiratory distress syndrome but is a disease of adults.
The causes of acute respiratory distress syndrome include any injury which causes swelling of the lung. This can be blunt or penetrating trauma to the lungs, aspiration of vomitus into the lungs, chemical inhalation in the lungs, septic shock, or pneumonia. Fluid builds up in the air sacs, making the lungs heavy with fluid. Oxygen cannot get to the air sacs and the oxygen level drops severely. Even if the individual gets oxygen through an alternative source, the mechanics of the lung involved with ARDS does not allow the air to get into the lung spaces. The lungs become stiff and cannot inhale and exhale properly.
Symptoms of adult respiratory distress syndrome include rapid and laboured breathing, shortness of breath, failure of at least one other body system, such as the liver or the kidneys, and low blood pressure, which contributes to organ failure. The symptoms tend to begin within one to two days of the original illness or injury.
Diagnosis of ARDS includes listening to the lungs with a stethoscope and hearing abnormal breath sounds, including crackles and fluid in the lungs. Doctors will often notice a low blood pressure and cyanosis is often seen in severely ill patients. This means that their skin, lips and nails are blue. Doctors can also check the arterial blood gases in order to determine that there is a low blood oxygen. Bronchoscopy can show damage to the lungs and fluid collection. A regular chest x-ray will show a "white out" in the lungs from fluid collection. CBC and blood chemistries can show if there is an infection or if there is organ failure. The sputum is checked for the presence of organisms and can be cultured. The blood can be cultured as well. An echocardiogram can be done to make sure the condition is ARDS and isn't congestive heart failure.
Treatment of those with acute respiratory distress centre begins with hospitalization in an intensive care unit. Breathing support is a strong part of the treatment as is treatment of the underlying condition. Antibiotics and steroids are used to block any infection going on and inflammation is reduced as a result. Lasix is used to draw fluid out of the lungs and to help the kidneys continue to work effectively. Most patients are on a respiratory and a continuous positive pressure is used to push oxygen into the lungs under force. This is called PEEP. It stands for positive end expiratory pressure and is used to make sure the patient is oxygenated. Sedation is required in order to use PEEP and this keeps the patient comfortable.
All in all, about a third of people with ARDS eventually die from the disease. If you survive ARDS, you often get normal lung function back again, although some have permanent lung damage, which is often mild in nature. In some people, surviving ARDS means you have memory loss or other problems with thought after the recovery time. This is because of brain damage from hypo-oxygenation during the event.
Complications of ARDS include damage to the lungs, such as pneumothorax because of the high settings on the PEEP on the ventilator. There can be multiple organ system failure, ventilator-associated pneumonia, and scar tissue on the lungs, called pulmonary fibrosis.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here