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Acute Respiratory Distress Syndrome (ARDS)

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This information was reviewed and approved by James K. O'Brien, MD, FACP, FCCP (4/15/2020).

What is acute respiratory distress syndrome or ARDS?

Acute respiratory distress syndrome (ARDS) is a potentially life-threatening injury to the lungs. ARDS is caused by a severe inflammatory response in your body when there is a severe infection or after trauma. This inflammation causes fluid to leak into the lungs, which makes it extremely difficult to breathe and decreases the amount of oxygen going into the bloodstream. The lack of oxygen can harm the brain, kidneys, and other internal organs. Acute respiratory distress syndrome can progress rapidly, be unpredictable and can cause death. Treatment and recovery for acute respiratory distress syndrome can take weeks to months. 

What are the signs and symptoms of acute respiratory distress syndrome (ARDS)?

Most people who develop ARDS are already in the hospital because of another disease or injury. Fluid buildup in the lungs can cause the lungs to become stiff and sometimes scarred. Stiff or scarred lungs make it difficult to breathe because it takes more work to breath. Fluid in the air sacks also makes it harder for oxygen to get into the blood. The most common signs and symptoms of ARDS are shortness of breath, rapid breathing and rapid heartbeat. Other symptoms of acute respiratory distress syndrome can include cough with or without mucus, blue lips or fingernails, chest pain during breathing, extreme fatigue and low blood pressure.


How is ARDS diagnosed?

A variety of tests are used to diagnose ARDS and rule out other conditions. A chest X-ray shows if there is fluid or pneumonia in one or both lungs. Blood cultures determine if there is an infection in the blood and can indicate the source of acute respiratory distress syndrome. An arterial blood-gas test measures how much oxygen and carbon dioxide are in the blood to show how well the lungs are working. A sputum sample is tested to help determine the cause of infection. (Sputum or phlegm is a gooey substance that is coughed up when there is an infection in the lungs or airways.) A CT scan provides detailed images of the heart, lungs and abdomen and identifies possible sources of acute respiratory distress syndrome. Electrocardiogram and echocardiogram can rule out certain heart conditions that can be mistaken for ARDS.


How is acute respiratory distress syndrome (ARDS) treated?

Treatments for ARDS include supplemental oxygen, a ventilator and medication. Supplemental oxygen ensures that the blood and body have enough oxygen to function properly. A mechanical ventilator supports the extra work it takes to breathe. Medication or other interventions treat the underlying cause of ARDS. Sometimes, an extracorporeal membrane oxygenation (ECMO) machine may be used to oxygenate the blood outside the body while the body fights the infection or trauma and repairs itself. Sedation is often used to prevent anxiety caused from being on these machines. Other treatments can include laying the patient on their stomach to help the lungs work better. Sometimes a feeding tube is placed to ensure the body is getting proper nutrition. Treatment can take days to weeks depending on the severity of the infection.

After the patient is taken off of the ventilator, pulmonary rehabilitation can help rebuild strength. Patients can sometimes develop post-traumatic stress disorder (PTSD) and sleep problems after being in an intensive care unit for a long time. Emotional support can be helpful in dealing with anxiety, stress and depression that are common with severe illness and prolonged hospital stays.

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