• Adult Respiratory Distress Syndrome

    (ARDS; Acute Respiratory Distress Syndrome; Non-cardiogenic Pulmonary Edema)

    Definition

    Adult respiratory distress syndrome (ARDS) is a form of lung failure. It is a life-threatening lung condition. ARDS can occur in very ill or severely injured people. It is not a specific disease.
    ARDS starts with the tiny blood vessels in the lungs. These vessels leak fluid into the lung sacs. The fluid decreases the ability of the lungs to move oxygen into the body.
    ARDS can develop in anyone over the age of one year old.
    If you suspect you or someone else has this condition, get medical help immediately.
    Adult Respiratory Distress Syndrome
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    Copyright © Nucleus Medical Media, Inc.

    Causes

    ARDS can be caused by many types of injuries, including:
      Direct injury to the lungs:
      • Chest trauma, such as a heavy blow
      • Aspiration of stomach contents
      • Obstructed airways
      • High attitude disease
      • Tuberculosis
      • Oxygen toxicity
      • Radiation
      • Cardiopulmonary bypass
      • Breathing smoke, chemicals, or salt water
      • Burns
      Indirect injury to the lungs:
      • Severe infection
      • Massive blood transfusion
      • Pneumonia
      • Shock
      • Burn
      • Head trauma
      • Severe inflammation of the pancreas ( pancreatitis )
      • Overdoses of alcohol or certain drugs (eg, aspirin, cocaine, opioids, phenothiazines, and tricyclic antidepressants)
    ARDS may occur within few days of a lung or bone marrow transplantation.

    Risk Factors

    ARDS develops most often in people who are being treated for the conditions listed above. Very few who have these issues will go on to develop ARDS.
    Factors that may increase your risk of ARDS include:
    • Cigarette smoking
    • Chronic lung disease
    • Age over 65

    Symptoms

    If you have any of these symptoms do not assume it is due to ARDS. These may be caused by other, more or less serious health conditions. If you or someone else is experiencing any one of them, seek medical help:
    • Shortness of breath
    • Fast, labored breathing
    • Bluish skin or fingernail color
    • Rapid pulse
    • Fever
    • Chills
    • Muscle pain or weakness
    • Headache
    • Dry Cough
    They often develop within 24-48 hours of the injury.

    Diagnosis

    Doctors may suspect ARDS when:
    • A person suffering from severe infection or injury develops acute, severe breathing problems
    • A chest x-ray shows fluid in the air sacs of both lungs
    • Blood tests show a dangerously low level of oxygen in the blood
    • Other conditions that could cause breathing problems have been ruled out
    The doctor will ask about symptoms and medical history. A physical exam will be done. People who develop ARDS may be too sick to complain of symptoms. If a patient shows signs of developing ARDS, tests may include the following:
    • Blood pressure check
    • Blood tests—to look for oxygen levels, evidence of infection (complete blood count, viral and bacterial cultures) and markers of heart failure
    • Chest x-ray
    • Swabs from nose and throat for identifying viruses
    • Occasionally, an echocardiogram (heart ultrasound), to rule out congestive heart failure
    • Pulmonary artery catheterization to aid in diagnostic work-up
    • Bronchoscopy to analyze airways—A laboratory examination may indicate presence of certain viruses or cancer cells
    • Open lung biopsy is reserved for cases when diagnosis is difficult to establish

    Treatment

    Talk with the doctor about the best plan for you. Treatment options include the following:
    • Treating the underlying cause or injury
    • Providing support until the lungs heal:
      • Mechanical ventilation—a machine to help you breathe through a tube placed in the mouth or nose, or through an opening created in the neck
      • Monitoring blood chemistry and fluid levels
      • Oxygen via a face mask or nasal prong
    Often, ARDS patients are sedated to tolerate these treatments.

    Prevention

    To help reduce your chances of getting ARDS, seek timely treatment for any direct or indirect injury to the lungs.

    RESOURCES

    American Lung Association http://www.lungusa.org/

    National Library of Medicine http://www.nlm.nih.gov/

    CANADIAN RESOURCES

    Canadian Lung Association http://www.lung.ca/home-accueil%5Fe.php/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    ARDS. National Heart, Lung, and Blood Institute Disease and Conditions Index website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Ards/Ards%5FWhoIsAtRisk.html . Accessed December 12, 2006.

    ARDS Support Center. Understanding ARDS: acute respiratory distress syndrome and its effect on victims and loved ones. ARDS Support Center brochure. October 3, 2001. ARDS Support Center website. Available at: http://www.ards.org/learnaboutards/whatisards/brochure/ . Accessed December 12, 2006.

    Bernard GR. Acute respiratory distress syndrome: a historical perspective. Am J Respir Crit Care Med. 2005;172:798.

    Bernard G, Artigas A, Carlet J, et al. The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818.

    Bosma KJ, Lewis JF. Emerging therapies for treatment of acute lung injury and acute respiratory distress syndrome. Expert Opin Emgerg Drugs . 2007;12: 461-77.

    DynaMed Editorial Team. Acute respiratory distress syndrome (ARDS). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated October 13, 2010. Accessed October 20, 2010.

    Jain R, DaiNogare A. Pharmacological therapy for acute respiratory distress syndrome. Mayo Clin Proc . 2006;81:205-12.

    National Heart, Lung, and Blood Institute. ARDS. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Ards/Ards%5FWhoIsAtRisk.html . Accessed August 4, 2005.

    Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353:1685.

    Udobi KF, Childs E, Touijer K. Acute Respiratory Distress Syndrome. Am Fam Physician . 2003;67(2):315-22.

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