Adult Respiratory Distress Syndrome (ARDS)

What is Adult Respiratory Distress Syndrome (ARDS)?

Acute respiratory distress syndrome (ARDS), also known as respiratory distress syndrome (RDS) or Acute Lung Injury(ALI) is a serious reaction to various forms of injuries or acute infection to the lung. ARDS is a severe lung syndrome (not a disease) caused by a variety of direct and indirect issues. It is characterized by inflammation of the lung parenchyma(tissue) leading to impaired gas exchange with concomitant systemic release of inflammatory mediators causing inflammation, hypoxemia and frequently resulting in multiple organ failure. This condition is often fatal, usually requiring mechanical ventilation and admission to an intensive care unit.

ARDS is often caused by lung contusions, severe pneumonia, aspiration of gastric/ stomach content, severe infections, massive blood transfusions, pancreatitis, severe trauma or burns.

Those disturbances can cause the body to leak fluids from the veins or arteries into the lungs, causing Pulmonary Oedema, by having excess fluids in the lungs, making a gas exchange(oxygenation) almost impossible. This process can take a few hours or can occur over a number of days.

  • What does the Respiratory system do?
  • Abnormal and or inadequate breathing
  • What Happens in Intensive Care?
  • How long will my loved one remain in Intensive Care?

 

What does the Respiratory System do ?

The respiratory system consists of the lungs, airways and blood vessels. The respiratory system inhales oxygen into the body and exchanges oxygen by removing carbon dioxide from the body. A normal breath requires a complex coordination between the nervous system (brain & spinal cord) and the muscles of breathing (including the diaphragm and muscles between the ribs).

Abnormal and or inadequate breathing can occur as a result of:

  • An interruption to the nervous system (head injuries or spinal injuries for example)
  • Barriers to the absorption of oxygen (eg fluid or secretions in the alveoli);
  • Obstruction to the flow of gases through the lungs, both breathing in or out (eg asthma);
  • Damage to the rib cage such as rib fractures or flail chest(in motor vehicle trauma for example);
  • Pneumothorax(deflation of one part of the lung)
  • Haemothorax(infiltration with blood to parts of the lung)
  • Pain, which makes taking a normal breath difficult

 

A number of respiratory conditions can result in respiratory failure and require Intensive Care or High dependency Unit admission. It is often that respiratory failure results in ventilation support (help with breathing). This support may be through the use of oxygen masks, BIPAP or Non- Invasive Ventilation(NIV) or via a Breathing Tube (endotracheal tube) and Ventilators (Breathing Machines)

What happens in Intensive Care?

Your loved one can be admitted to an intensive care because it is thought they have or may be developing ARDS, but it is more likely that they are Patient in Intensive Care already for other reasons. The treatment for ARDS revolves around supporting the lungs until they can repair themselves.

  • Full ventilation using a Ventilators(Breathing Machine) and a Breathing Tube (endotracheal tube) will usually be required to improve the oxygen delivery
  • Tracheostomy ventilation whenever prolonged ventilation (>2 weeks) is deemed inevitable
  •  Your loved one will require monitoring using a Bedside Monitors and an Arterial Catheter(Arterial Line)
  •  You can expect your loved one to have frequent Chest X-rays and blood tests(Blood& Pathology tests in Intensive Care) especially arterial blood gases (ABGs)
  • Use of a Pulmonary Artery Catheters or a PICCO catheter to closely monitor cardiac function is not uncommon.
  • In some instances ventilation with Nitric Oxide may be the treatment of choice, alternatively Prostacyclin Nebulisers may be administered
  • In some cases oscillation ventilation may be considered
  • Under extreme circumstances where oxygen uptake cannot be improved alternative treatments such as ECMO(Extracorporeal Membrane Oxygenation) or procedures such as or prone ventilation may be considered
  • Appropriate antibiotic therapy must be administered as soon as microbiological culture results are available. More than 60% ARDS patients experience a hospital(nosocomial) acquired pulmonary infection either before or after the onset of lung injury
  • The origin of infection, when surgically treatable, must be operated on. When sepsis is diagnosed, appropriate local protocols should be enacted.

 

How long will your loved one remain in Intensive Care?

Your loved ones prognosis and length of stay in intensive care is closely linked to the severity of the ARDS, failure of other organs (especially the kidneys, liver, heart and brain) and whether he or she has an infection. The survival rate is around 65%. Patients who survive ARDS, usually fully recover, however it is a long and slow process.

Any Questions?

Of course, if you have any questions or concerns, please discuss them with the ICU nurses and doctors.

All Intensive Care interventions and procedures carry a degree of potential risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for your loved one.

The information contained on this page is general in nature and therefore cannot reflect individual Patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. INTENSIVE CARE HOTLINE attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual Patient. Please refer to the full disclaimer.

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