Acute Respiratory Distress Syndrome (ARDS)

Acute Respiratory Distress Syndrome (ARDS)

Acute respiratory distress syndrome (ARDS) is a life-threatening lung injury that allows fluid to leak into the lungs. Breathing becomes difficult and oxygen cannot get into the body. Most people who get ARDS are already at the hospital for trauma or illness.
Key Facts

• Acute respiratory distress syndrome (ARDS) occurs when our lungs are severely injured, often by infection or trauma.
• Many people who get ARDS are already in the hospital due to an infection or a trauma. But if you are not and your symptoms suggest ARDS, go to the nearest ER immediately.
• ARDS causes fluid to leak into the lungs, making it difficult to get oxygen into the bloodstream.
• Treatment is improving and more people are surviving ARDS now than in the past. Survival can depend on age and presence of other medical problems.

How ARDS Affects Your Body

In the early stages of ARDS, fluid from the smallest blood vessels in the lungs starts to leak into the alveoli—the tiny air sacs where oxygen exchange takes place. The lungs become smaller and stiffer and it becomes hard to breath. The amount of oxygen in the blood falls. This is called hypoxemia. The body becomes starved for oxygen. This harms the brain and other tissues and leads to organ failure.

ARDS patients need help to open closed airspaces, get oxygen into the blood and make it easier to breath. A ventilator and extra oxygen are used for these reasons and maintained until the injury resolves.

What Causes ARDS?

ARDS results from lung injury. The exact nature of the injury is not always clear. Common injuries are:

• Sepsis, a life-threatening condition occurs when your immune system must work aggressively to fight off infection or trauma
• Inhaling harmful substances
• Pneumonia
• Trauma to the head, chest or other areas of the body
• Blood transfusions
• Pancreatitis
• Near drowning

Who Is at Risk for ARDS?

Most people who develop ARDS are already in the hospital because of injury or illness. While it is not clear who will develop ARDS, certain factors may increase the risk for ARDS including:

• Advanced age
• A history of tobacco use
• A history of alcoholism
• Presence of chronic lung disease
• High-risk surgery

What Are Symptoms of ARDS?

Patients with ARDS are short of breath, often to a distressing level. They are breathing faster and their heart is beating faster. They may have pain as they try to take a breath. As the oxygen in the blood falls, their fingernails and lips may have a bluish color.

How Is ARDS Diagnosed?

When patients present with the above symptoms, doctors will do a chest X-ray to look for fluid in the lungs and a blood test to find out the severity of the oxygen starvation. ARDS has to be separated from heart failure and chronic lung disease. Doctors suspect ARDS if they can identify a lung injury. If you have heart disease or chronic lung disease, this may be more difficult because ARDS and heart problems have similar symptoms.

Related Blogs

• What to Know if Your Loved One is Diagnosed with ARDS

ARDS is a serious condition that can be frightening for patients and their loved ones. The outcomes tend to be better in younger patients, trauma patients and when ARDS is caused by blood transfusions. Chances of survival and recovery are better for those who recover before other organs begin to fail. Liver failure, kidney failure and severely decreased blood pressure are some common warning signs of a potentially life-threatening situation. Survivors can recover full or partial lung function due to scarring. Health problems outside of the lung such as muscle weakness or fatigue can persist for as long as a year.

How Is ARDS Treated?

There is no cure for ARDS at this time. Treatment focuses on supporting the patient while the lungs heal. The goal of supportive care is getting enough oxygen into the blood and delivered to your body to prevent damage and removing the injury that caused ARDS to develop.

Ventilator support

All patients with ARDS will require extra oxygen. Oxygen alone is usually not enough, and high levels of oxygen can also injure the lung. A ventilator is a machine used to open airspaces that have shut down and help with the work of breathing. The ventilator is connected to the patient through a mask on the face or a tube inserted into the windpipe.

Prone positioning

ARDS patients are typically in bed on their back. When oxygen and ventilator therapies are at high levels and blood oxygen is still low, ARDS patients are sometimes turned over on their stomach to get more oxygen into the blood. This is called proning and may help improve oxygen levels in the blood for a while. It is a complicated task and some patients are too sick for this treatment.

Sedation and medications to prevent movement

To relieve shortness of breath and prevent agitation, the ARDS patient usually needs sedation. Sometimes added medications called paralytics are needed up front to help the patient adjust to the ventilator. These medications have significant side effects and their risks and benefits must be continuously monitored.

Fluid management

Doctors may give ARDS patients a medication called a diuretic to increase urination in hopes of removing excess fluid from the body to help prevent fluid from building up in the lungs. This must be done carefully, because too much fluid removal can lower blood pressure and lead to kidney problems.

Extracorporeal membrane oxygenation (ECMO)

ECMO is a very complicated treatment that takes blood outside of your body and pumps it through a membrane that adds oxygen, removes carbon dioxide and then returns the blood to your body. This is a high-risk therapy with many potential complications. It is not suitable for every ARDS patient.

Recovering from ARDS

ARDS patients may require ventilation for long periods of time. On average this is seven to 14 days. Beyond this time, doctors may suggest a tube be placed directly into the windpipe through the neck (tracheostomy) by a surgeon. Usually the doctor believes it may take weeks more to recover from ventilator support. This tube can easily be removed once the patient is free of the need for a ventilator. It is important to note that most people survive ARDS. They will not require oxygen on a long-term basis and will regain most of their lung function. Others will struggle with muscle weakness and may require re-hospitalization or pulmonary rehabilitation to regain their strength.

For More Information: Consult the ARDS Foundation

Questions to Ask Your Doctor about ARDS

Because many people with ARDS are hospitalized, it can be helpful to have a caregiver present when consulting your physicians. Ask your doctor the following questions to better understand an ARDS diagnosis:

• What is the prognosis for survival and discharge from the hospital in ARDS? Just how sick is my family member with ARDS?
• What are the main risks/side effects of mechanical ventilation?
• If someone requires mechanical ventilation, how long does it take to be weaned?
• If my family member has an acute episode of ARDS and can be discharged from the hospital, how long until they reach maximum recovery?
• What are the chances my family member will be able to recover to their previous level of lifestyle activity?

Source: https://www.lung.org/lung-health-diseases/lung-disease-lookup/ards