Acute Respiratory Distress Syndrome (ARDS)

Acute Respiratory

Acute Respiratory Distress Syndrome (ARDS) is a type of pulmonary insufficiency caused by various disorders that cause fluid accumulation in the lungs (pulmonary edema). This syndrome is considered a medical emergency that can occur even in people who previously had normal lungs. Although it may sometimes be called adult respiratory distress syndrome, this disorder may also occur in children.

What are the causes?

The cause may be any disease that directly or indirectly causes lung injury. Approximately one-third of individuals with the syndrome develop it due to a widespread and serious infection (sepsis). When the alveoli and pulmonary capillaries are damaged, blood and fluid escape into the interalveolar spaces and finally into the alveoli. Subsequent inflammation can lead to the formation of scar tissue. As
consequently, the lungs can not function normally.

What are the Symptoms and Diagnosis?

Typically, acute respiratory distress syndrome occurs 24 or 48 hours after the injury or the original illness. Initially, the individual is short of breath, almost always accompanied by a superficial and rapid breathing. With the help of a stethoscope, the doctor may hear crackling sounds or wheezing in the lungs. Due to the low levels of oxygen in the blood, the skin may become mottled or bluish and the function of other organs, such as the heart and brain, may be compromised.

Arterial blood gases reveal low levels of oxygen in the blood and radiographies indicate the presence of fluid in the spaces that should be filled with air. Sometimes other tests are needed to confirm that the cause of the problem is not heart failure.

Main causes of Acute Respiratory Distress Syndrome

  • Severe disseminated infection (septicemia);
  • Pneumonia;
  • Severe arterial hypotension (shock);
  • Aspiration of food into the lungs;
  • Multiple blood transfusions;
  • Pulmonary injury resulting from elevated oxygen concentrations;
  • Pulmonary embolism;
  • Thoracic injury;
  • Burns;
  • Drowning;
  • Cardiopulmonary bypass surgery;
  • Inflammation of the pancreas (pancreatitis);
  • Excessive dose of some type of drug, such as heroin, methadone, propoxyphene or aspirin.

What are the complications and prognosis?

The lack of oxygen caused by this syndrome can produce complications in other organs soon after the onset of the condition or, when there is no improvement in the condition, over days or weeks. Prolonged lack of oxygen can cause serious complications, such as kidney failure. Without immediate treatment, severe oxygen deprivation caused by the syndrome causes death in 90% of patients.

However, with proper treatment, about 50% of affected individuals survive. As individuals with acute respiratory distress syndrome are less resistant to lung infections, they commonly develop bacterial pneumonia at some point in the course of the disease.

How is the treatment done?

Patients with acute respiratory distress syndrome are treated in the intensive care unit. Oxygen therapy is essential for the correction of low oxygen levels. If oxygen administered with the use of a face mask does not correct the problem, a ventilator should be used. It delivers oxygen under pressure through a tube inserted into the nostril, mouth, or trachea. This pressure helps force the passage of oxygen to the blood.

The pressure is adjusted to help keep the small airways and alveoli open, and to ensure that the lungs do not receive an excessive concentration of oxygen. This is important because too much oxygen concentration can injure the lungs and aggravate acute respiratory distress syndrome. It is also important to institute other adjuvant treatments, such as the administration of liquid or nutrients through the intravenous route, since dehydration or malnutrition increases the likelihood of disruption of the functioning of multiple organs (multiple organ failure).

Additional treatment crucial to success depends on the underlying cause of acute respiratory distress syndrome. For example, antibiotics are given to fight an infection. Patients who respond normally to treatment regain well with little or no long-term pulmonary change. For those patients whose treatment depends on long periods under assisted breathing (with the aid of a ventilator), the possibility of pulmonary scar formation is greater. However, these scars may improve a few months after the patient has stopped using the ventilator.

What are Nursing Care with the patient in ARDS?

  • Reassure the client in psychological support;
  • Encourage semi – Fowler or Fowler position for better ventilation;
  • Perform Hydrolitic control;
  • Observe distension of the jugular vein (peripheral edema);
  • Provide adequate nutritional support;
  • Provide assisted diet;
  • Maintain calibrated venous access, pulse oximeter and cardiac monitor;
  • Maintain oral (tracheobronchial) and body hygiene;
  • Assist the physician in endotracheal or orotracheal intubation, and in mechanical ventilation;
  • Administer medications according to medical prescription;
  • Check vital signs;
  • Observe, communicate and note intercurrences.