Acute respiratory distress syndrome

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Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that prevents enough
oxygen from getting to the lungs and into the blood. Infants can also have respiratory distress
syndrome.
Causes
ARDS can be caused by any major direct or indirect injury to the lung. Common causes include:

Breathing vomit into the lungs (aspiration)

Inhaling chemicals

Lung transplant

Pneumonia

Septic shock (infection throughout the body)

Trauma

ARDS leads to a buildup of fluid in the air sacs (alveoli). This fluid prevents enough oxygen from
passing into the bloodstream.
The fluid buildup also makes the lungs heavy and stiff, which decreases the lungs' ability to expand.
The level of oxygen in the blood can stay dangerously low, even if the person receives oxygen from a
breathing machine (ventilator) through a breathing tube (endotracheal tube).
ARDS often occurs along with the failure of other organ systems, such as the liver or kidneys.
Cigarette smoking and heavy alcohol use may be risk factors.
Symptoms
Symptoms usually develop within 24 to 48 hours of the injury or illness. Often, people with ARDS are
so sick they cannot complain of symptoms. Symptoms can include any of the following:

Difficulty breathing

Low blood pressure and organ failure

Rapid breathing

Shortness of breath

Exams and Tests

Listening to the chest with a stethoscope (auscultation) reveals abnormal breath sounds, such as
crackles, which may be signs of fluid in the lungs. Often, blood pressure is low. Cyanosis (blue skin,
lips, and nails caused by lack of oxygen to the tissues) is often seen.

Tests used to diagnose ARDS include:

Arterial blood gas

Blood tests, including CBC and blood chemistries

Blood and urine cultures

Bronchoscopy

Chest x-ray

Sputum cultures and analysis

Tests for possible infections

An echocardiogram or Swan-Ganz catheterization may be needed to rule out congestive heart failure,
which can look similar to ARDS on a chest x-ray.
Treatment
ARDS often needs to be treated in an intensive care unit (ICU).
The goal of treatment is to provide breathing support and treat the cause of ARDS. This may involve
medicines to treat infections, reduce inflammation, and remove fluid from the lungs.
A ventilator is used to deliver high doses of oxygen and continued pressure (positive end-expiratory
pressure, or PEEP) to the damaged lungs. Patients often need to be deeply sedated with medicines.
During treatment, doctors and nurses make every effort to protect the lungs from further damage.
Support Groups
Many family members of people with ARDS are under extreme stress. Often they can relieve this
stress by joining support groups where members share common experiences and problems.
Outlook (Prognosis)
About a third of people with ARDS die of the disease. Those who live usually get back most of their
normal lung function, but many people have permanent (usually mild) lung damage.
Many people who survive ARDS have memory loss or other quality-of-life problems after they recover.
This is due to brain damage that occurred when the lungs were not working properly and the brain
was not getting enough oxygen.
Possible Complications

Failure of many organ systems

Lung damage (such as a collapsed lung--also called pneumothorax) due to injury from the
breathing machine needed to treat the disease

Pulmonary fibrosis (scarring of the lung)

Ventilator-associated pneumonia

When to Contact a Medical Professional

Usually, ARDS occurs during another illness, for which the patient is already in the hospital. In some
cases, a healthy person has severe pneumonia that gets worse and becomes ARDS. If you have
trouble breathing, call your local emergency number (such as 911) or go to the emergency room.
Alternative Names
Noncardiogenic pulmonary edema; Increased-permeability pulmonary edema; ARDS; Acute lung
injury
References
Herridge MS. Recovery and long-term outcome in acute respiratory distress syndrome. Crit Care Clin.
2011;27:685704.
Lee WL, Slutsky AS. Acute respiratory distress syndrome. In: Mason RJ, Murray JF, Broaddus VC, et
al., eds.Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Elsevier
Saunders; 2010:chap 90.
Update Date: 2/8/2014
Updated by: Denis Hadjiliadis, MD, Associate Professor of Medicine, Pulmonary, Allergy, and Critical
Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by
David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team