ACUTE RESPIRATORY DISTRESS SYNDROME

INTRODUCTION
Acute respiratory distress syndrome (ARDS) is a serious lung condition that causes low
blood oxygen. People who develop ARDS are usually ill due to another disease or a major
injury. In ARDS, fluid builds up inside the tiny air sacs of the lungs, and surfactant breaks down.
Surfactant is a foamy substance that keeps the lungs fully expanded so that a person can breathe.
These changes prevent the lungs from filling properly with air and moving enough oxygen into
the bloodstream and throughout the body. The lung tissue may scar and become stiff. ARDS may
develop over a few days, or it can get worse very quickly. The first symptom of ARDS is usually
shortness of breath. Other signs and symptoms of ARDS are low blood oxygen, rapid breathing,
and clicking, bubbling, or rattling sounds in the lungs when breathing.

ARDS can develop at any age. To diagnose ARDS, your doctor or your child’s doctor will do a
physical exam, review the patient’s medical history, measure blood oxygen levels, and order a
chest X-ray. Supplying oxygen is the main treatment for ARDS. Other treatments help make you
more comfortable or aim to eliminate the cause of ARDS. Treatments for ARDS may help
prevent serious or life-threatening complications, including organ damage or organ failure.

1, CAUSES AND RISK FACTORS

Damage to the lung’s air sacs—called alveoli—causes ARDS. Fluid from tiny blood vessels
leaks through the damaged walls of the air sacs and collects, limiting the lungs’ normal exchange
of oxygen and carbon dioxide. The damage also causes inflammation that leads to the breakdown
of surfactant—a liquid that helps keep your air sacs open. The air sacs may become damaged as
a result of an illness, such as a lung infection, or breathing in smoke. Other illnesses or injuries
may trigger inflammation that damages the air sacs. To understand ARDS, you may also want to
read about how the lungs work.
You may have an increased risk of ARDS because of infection, environmental exposures,
lifestyle habits, genetics, other medical conditions or procedures, race, or sex. Risk factors can
vary depending on your age, overall health, where you live, and the healthcare setting in which
you receive care.
Infections are the most common risk factors for ARDS. These may include:
 Flu or other viruses, such as respiratory syncytial virus and SARS-CoV-2, the virus
responsible for COVID-19. Watch this videoexternal link to learn more about how
COVID-19 affects the lungs. Additionally, we offer information and resources on how
we are working hard to support necessary COVID-19 research. 
 Pneumonia
  Sepsis, a condition in which bacteria infect the bloodstream
 Uterine infection in the mother, affecting a newborn’s lungs
Environment. Being exposed to air pollution for weeks or months can make you more
vulnerable to ARDS.
Lifestyle Habits. Habits that harm the health of your lungs increase your risk of ARDS. These
include:
 Heavy alcohol use
 Overdose of illegal drugs
 Smoking
Family history and genetics. The genes you inherit may put you at an increased risk for ARDS.
These genes play a role in how the lungs respond to damage.
Other medical conditions, injuries, or medical procedures can raise your risk for ARDS.
These may include:
 Blood transfusions
 Fat embolism, in which a clot of fat blocks an artery. A physical injury, such as a broken
bone, can lead to a fat embolism.
 Hemorrhagic shock
 Inhaling vomit, smoke, chemical fumes, or water during a near drowning
 Injury, such as from a blow or burns
 Lung injury from being on a ventilator
 Lung or heart surgery, or being placed on a heart-lung bypass machine
 Newborn lung conditions, which can raise the risk of your baby having neonatal
ARDS. These include pneumonia and a condition where the unborn baby passes stool
while still in the womb, and the stool is then inhaled into his or her lungs. Your baby is
also at higher risk if he or she did not get enough oxygen during delivery.
 Pancreatitis, a condition in which the pancreas becomes infected. The pancreas is a
gland that releases enzymes and hormones.
 Pulmonary vasculitis
 Reaction to medicine, such as those used to treat cancer or arrhythmia
Race or ethnicity. The risk of developing ARDS is higher among nonwhite groups.
Sex. Among children, boys are at a higher risk of ARDS than girls are.
2. PATHOPHYSIOLOGY

3. DIAGNOSIS
Your doctor will diagnose ARDS based on your medical history, a physical exam, and test
results. ARDS can be difficult to diagnose and is often mistaken for another condition, so it is
important to know your symptoms.
 Medical history. To help diagnose ARDS, your doctor may ask you about any medical
conditions or recent events that could be considered risk factors. For example, travelling
could be a risk factor because of potential exposure to infections that are more common
in certain geographic areas. Your doctor may also ask about your symptoms and whether
you have a heart problem, such as heart failure, or another condition that can cause signs
and symptoms similar to those for ARDS.
 Physical exam. Your doctor will examine you for signs of ARDS. This exam may
include:
 Listening to your lungs through a stethoscope for abnormal breathing sounds,
such as crackling
 Listening to your heart for a fast heart rate
 Checking for signs that you are having difficulty breathing, such as using
muscles in your chest to help you breath
 Examining your skin or lips for a bluish tone, which can signal a low blood
oxygen level
 Examining your body for swelling or other signs of extra fluid, which may be
linked to heart or kidney problems
 Measuring your blood pressure and oxygen levels
 Diagnostic tests and procedures. To diagnose ARDS, your doctor may have you
undergo some of the following tests and procedures. Different tests may be appropriate
for different ages.
 Blood tests to measure the oxygen level in your blood using a sample of blood
taken from an artery. A low blood oxygen level might be a sign of ARDS. In
order to confirm the cause of your symptoms, your doctor may also check your
blood for signs of infection or a heart problem, or to see how well other organs
are working.
 Chest X-ray to create detailed images of the inside of your chest. This test is
generally the standard for showing excess fluid in your lungs.
 CT (computed tomography) scan of the chest or abdomen to create detailed
images of your lungs or check for abdominal infections.
 Other tests of blood oxygen levels, such as pulse oximetry, that do not require
collecting a blood sample. For these tests, a sensor is attached to the skin or
placed on a hand or foot.
 Test for other medical condition. Other tests can help find the cause of your ARDS or
determine if there is another type of problem. These include:

 A sputum culture to help find the cause of an infection. The culture is used to
study the phlegm you have coughed up from your lungs.
 Bronchoscopy to diagnose a lung problem when there is no clear cause of your
ARDS. As part of this test, your doctor may rinse an area of your lung to get cells
and examine them under a microscope or with other tests.
 Echocardiogram or a lung ultrasound. These tests can help your doctor rule
out heart failure, congenital heart defects, or other breathing problems.
 Lung biopsy, when other tests do not confirm a diagnosis
 Urine test to detect bacterial infections or rule out kidney problems
4, MEDICAL MANAGEMENT
The management of acute respiratory distress syndrome is (i) supportive treatment with
ventilation (ii) focused treatment of the underlying cause. It is highly likely that patients with
ARDS will require early intubation and ITU admission for respiratory and circulatory support.
The specific goals of ITU management of ARDS are complex, focusing on limiting the
inflammatory cascade and reducing alveolar injury. However, the main aspects of management*
involve:
 Maintaining the minimum intravascular volume required to ensure adequate tissue
perfusion, thus limiting excess oedema
 Lower tidal volumes used in ventilation, reducing shear forces from over-distension and
ventilator-associated lung injury
 Positive end-expiratory pressure, splinting airways and avoids the damage caused by the
cyclical opening of alveoli
Patients who remain severely hypoxic despite conventional therapy, Extra-Corporeal Membrane
Oxygenation (ECMO) can be considered
*Proning patients has also been shown to improve oxygenation and CO2 clearance, therefore
can be used in conjunction to the other ventilation measures
Pharmacological treatments of ARDS have in the past involved the use of artificial surfactant
and corticosteroids, however are used less in modern practice. Use of artificial surfactant can be
effective in neonatal cases, however has yielded no advantage in adults, whilst the use of
corticosteroids are not effective in the acute phase of ARDS (but may reduce ventilation days
when used 7-14 days after onset).

5. NURSING INTERVENTION
Fluid rushing into the respiratory tract and reaching the alveoli is the primary cause for ARDS.
So, how does one manage and intervene? How do you make sure that you’re decompressing and
minimizing inflammation to the respiratory tract? What are the important nursing interventions
that you need to do?
1. Give Corticosteroids. Some common corticosteroids are Solu-Medrol and Prednisone.
Clients are given corticosteroids to decrease inflammation in the respiratory tract. Take
note; if you provide corticosteroids to your client with ARDS, you are also decreasing the
movement of WBCs, thereby decreasing the immune response.
2. Give Antibiotics. Since ARDS is a condition wherein there’s a pooling of liquid inside
the lungs, the water becomes stagnant and is prone to becoming grounds for bacterial
growth. Therefore, the client is likely to developing pneumonia. For this reason,
 antibiotics are necessary to protect the respiratory tract from developing complications
and get rid of inflammation.
Remember that the primary goal why antibiotics are given is to alleviate inflammation and bring
the client’s breathing back to normal.
3. Turn the Client. Put the client in a 45-degree or 90-degree sitting position, and turn your
client every hour to make sure that the fluid inside the lungs is not stagnant in one place.
This will give parts of the lungs to breathe. Moving the client will also facilitate drainage
as steroids are provided.

6. COMPLICATION
 Blood clots-patients suffering from ARDS are prone to developing blood clots which
could lead to pulmonary embolism
 Collapsed lung (pneumothorax)-this is caused by a ventilator, the pressure and air volume
of the ventilator can cause the lung to collapse
 Infections-the ventilator is attached directly to a tube inserted in the windpipe, this may
lead to an infection
 Scarring (pulmonary fibrosis)- Scarring occurs between the air