Acute respiratory distress syndrome (ARDS) is a rapidly progressive

disease occurring in critically ill patients. The main complication in ARDS is

that fluid leaks into the lungs making breathing difficult or impossible.

Key Facts
ARDS occurs when there is trauma to the lungs, either directly or
indirectly.
Most people who get ARDS are already in the hospital for trauma or
illness.
ARDS causes fluid to leak into the lungs, making it difficult to get
oxygen into the blood.
ARDS can be associated with an acute medical problem or
procedure.

What Is ARDS?
ARDS is a buildup of fluid in the tiny air sacs in your lungs called alveoli.
This means less oxygen can get to your organs, which is very dangerous.
ARDS occurs when there is significant trauma that either affects the lungs
directly or indirectly. Some examples of trauma include sepsis (a blood
infection), breathing in smoke from a house fire, near-drowning, severe
pneumonia, major trauma, and shock from any cause. Your body responds
to this trauma with an inflammatory reaction that releases numerous natural
molecules into the bloodstream. Normally, this inflammatory reaction would
be protective and help you fight infection or heal from an injury. However, in
some people, these inflammatory molecules lead the smallest blood
vessels in the lungs to leak fluid. Fluid leaves these small vessels and goes
into the alveoli. The alveoli fill with this fluid making it difficult for oxygen to
get into the bloodstream.

How ARDS Affects Your Body

The fluid that leaks into the lungs makes it very difficult to breathe and
leads to low oxygen in the blood, or hypoxemia. The fluid in the lungs
makes the lungs stiff and difficult to inflate. This increases the work it takes
to breathe and get air into your lungs. When the body can't carry out the
work of breathing and has low oxygen levels, it causes respiratory failure.
In order to improve the amount of oxygen and reduce the work of
breathing, most ARDS patients will be placed on a ventilator to support
them while the lungs heal. If the inflammation and fluid in the lung(s)
persist, some patients will go on to develop scarring in the lungs. This is
known as the fibrotic stage of ARDS. It is during this stage that the lung can
"pop" and deflate, leading to a collapsed lung, also called a pneumothorax.

How Serious Is ARDS?

There are about 200,000 cases of ARDS each year in the United States.
Most people who get ARDS are already in the hospital in critical condition
from some other health complication or trauma. ARDS is a very serious
disease and even with the best medical care between 30 and 50 percent of
those diagnosed with ARDS die of it. Those surviving the disease will often
have long hospital stays. One of the biggest problems with this disease is
that many patients develop additional complications while they are in the
intensive care unit. Some of these complications include pneumonia,
collapsed lungs, other infections, severe muscle weakness, confusion, and
kidney failure.
This content was developed in partnership with the CHEST Foundation,
the philanthropic arm of the American College of Chest Physicians.
http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/ards/learnabout-ards.html

Diagnosing and Treating ARDS

Questions to Ask Your Doctor

How Is ARDS Diagnosed?

The diagnosis is based on your symptoms, vital signs, and a chest X-ray.
There is no single test to confirm the diagnosis of ARDS. Patients with
ARDS will have rapid onset of shortness of breath and very low oxygen
levels in the blood. The chest X-ray will show fluid present in both lungs
(often described as "infiltrates" by doctors reading chest X-rays). Since
ARDS and some heart problems have similar symptoms, your doctor might
perform certain tests to rule out a heart problem.

How Is ARDS Treated?

Because there is no direct cure for ARDS, treatment focuses on supporting
the patient while the lung heals. ARDS will often worsen in the first few
days following the diagnosis before the lung begins to heal. The goal of this
supportive care is to keep enough oxygen in the blood to prevent further
damage to your body and to treat whatever caused ARDS in the first place.
Another important part of the care for ARDS is to prevent and manage
complications related to being in an intensive care unit.

Ventilator support
All patients with ARDS will require oxygen therapy. Oxygen alone is usually
not enough, and you will likely need to be supported by a ventilator. A
ventilator is a machine that delivers breaths and oxygen therapy through a
tube inserted into the trachea or windpipe.

Prone positioning
Hospitalized patients are typically in bed on their backs. However, lying
face down (prone) may help improve oxygen levels in the blood and
increase survival in patients with ARDS. This can be a very complicated
task that takes an entire team to accomplish, and some patients may be
too sick for this treatment. There are specialized beds designed to help
position patients in the intensive care unit face down and, although they are
convenient, they are not absolutely necessary for this therapy.

Sedation and medications to prevent movement

It is uncomfortable and painful to be supported by a ventilator. This often
leads to restlessness and agitation, which can cause even more problems
for the lungs. In order to keep comfortable and prevent this, the patient may
need sedation to remain calm. There are medications called paralytics that
can temporarily prevent patients from moving. Because the side effects
related to these medications are significant, the risks and benefits need to
be closely considered.

Fluid management
Sometimes doctors will give patients with ARDS a medication called a
diuretic to help increase urination. This removes fluid from the body and
can help prevent fluid from building up in the lungs. This must be done
carefully, because too much fluid removal can lead to low blood pressure or
kidney problems.

ECMO
ECMO stands for extracorporeal membrane oxygenation. This is a very
complicated treatment that takes blood outside of your body and pumps it
through a membrane that adds oxygen and removes carbon dioxide and

then returns the blood to your body. This is a high-risk therapy with many
complications. It is not suitable for every patient.

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ARDS Symptoms, Causes & Risk

Factors
ARDS may initially be diagnosed as pneumonia or pulmonary edema (fluid
in the lungs from heart disease). However, your doctor may suspect ARDS
if you are not getting better and have one of the known causes of ARDS.

What Are Symptoms of ARDS?

Patients with ARDS have shortness of breath, often severe. They also have
a cough and many have fever. Those with ARDS also have fast heart rates
and rapid breathing. Occasionally, they experience chest pain, especially
during inhalation. Some patients who have very low oxygen levels may
have bluish coloring of nails and lips from the severely decreased oxygen
levels in the blood.

What Causes ARDS?

The causes of ARDS are divided into two categories: direct or indirect
injuries to the lung. Some of the direct injuries to the lung include
pneumonia, breathing stomach contents into the lung (also known as
aspiration), near drowning, lung bruising from trauma (such as a car
accident) and smoke inhalation from a house fire.

The indirect injuries to the lung include inflammation of the pancreas,

severe infection (also known as sepsis), blood transfusions, burns, and
medication reactions.
Fortunately, most patients with the above problems will not develop ARDS.
It is not known why some will.

What Are Risk Factors?

While it is not clear who will develop ARDS, there are a few factors that
may increase the risk for ARDS. These factors include:
A history of cigarette smoking
Oxygen use for a pre-existing lung condition
Recent high-risk surgery
Obesity
Low protein in the blood
Alcohol abuse
Recent chemotherapy

When to See Your Doctor

Most patients who develop ARDS will already be in the hospital, but some
may not be hospitalized. Call your doctor or 911 if you experience severe
shortness of breath, or if you have a new cough or fever.
http://www.lung.org/lung-health-and-diseases/lung-diseaselookup/ards/symptoms-causes-risk-factors.html

Recovering from ARDS

What to Expect
ARDS is a serious disease that can be frightening for patients and families
to endure. The outcomes tend to be better in younger patients, trauma
patients and when ARDS is caused by blood transfusions. Most people will
not die of the severely low oxygen levels in the blood associated with
ARDS. However, the chance of dying increases dramatically if other organs
begin to fail. This could include liver failure, kidney failure or severely
decreased blood pressure.

Managing the Disease

Often patients will require ventilation for longer periods of time. Although
there is no set time, after about 7 to 14 days, the doctors may need to
surgically place a tube that is surgically directly into the windpipe through
the neck (tracheostomy). This would only be placed if doctors felt it would
take longer than a few weeks to remove the patient from the ventilator. This
tube is not permanent and can easily be removed once the patient no
longer needs the ventilator.
It is important to note that people can survive ARDS. Most patients will not
require oxygen on a long-term basis and will regain most of their lung
function. Some people who survive ARDS struggle with weakness, which
might mean they end up in the hospital more frequently or need to seek out
therapy, such as pulmonary rehabilitation, to regain their strength.

Finding Support
Facing ARDS may cause fear, anxiety, depression, and stress for both
patients and their loved ones. Joining a support group may help you adjust

to your condition. You can see how other people who have the same
symptoms have coped with them. Talk to your doctor about local support
groups, or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety.
Let your loved ones know how you feel and what they can do to help you.
The Lung Association recommends patients and caregivers join our Living
with Lung Disease Support Communityto connect with others facing this
disease. You can also call the Lung Associations Lung Helpline at 1-800LUNGUSA to talk to a trained respiratory professional who can help answer
your questions and connect you with support.

http://www.lung.org/lung-health-and-diseases/lung-diseaselookup/ards/recovering-from-ards.html

medical surgical management

medical
the client with ARDS is cared for in the intensive care unit . the underlying cause of ARDS is
ascertained and treated; until that time, supportive care given. Mechanical ventilatory support
is necessary, with multiple other systems often also being supported. A mechanical ventilator
allows the oxygen percentage,pulmonary pressure, and lung volume to be controlled. Oxygen
action is monitored with ABGs and pulse oximetry. Respiratory secretions are removed by
frequent bronchial suctioning
Pharmacological
Pharmacological therapy includes high doses of corticosteroids such as hydrocortisone
sodium succinate (Solu-Cortef) or methylprednisolone sodium succinate ( Solu-Medrol).
Furosemide (lasix) and other diuretics are given to remove fluids and increase urinary output.
Aminophylline is administered to open the bronchi. While the client is on the mechanical
ventilator, pancuronium bromide (pavulon) is given to suppress the clients own respiratory
effort.blood pressure can fail dangerously low, and vasopressors such as dopamine
hydrocloride (intropin ) may be required to maintain the blood pressure within an acceptable
range.
Diet
Total parenteral nutrition (TPN) may be given to the client, especially during the acute phase
of the illness. When possible ,enteral feedings are preferred.

Activity
The client with ARDS will be on bed rest. Special beds taht provide movement nd pressure
adjustment prevent the complications associated with immobility. According to the ARDS
Support Center (2009). Prone positioning improves oxygenation and may prevent further
lung damage.