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Acute Respiratory Distress Syndrome (ARDS)

Overview

Acute respiratory distress syndrome (ARDS) is a medical condition in which fluid builds up in the alveoli (delicate, elastic air sacs) of your lungs. Lungs are vital organs of the body whose function is to exchange gases between air and the body. Lungs consist of a series of branching tubes( trachea, bronchi, bronchioles) that end into tiny air sacs called alveoli. The accumulation of this fluid in the alveoli prevents your lungs from effectively expanding with air resulting in lesser oxygen entering your circulation. Your organs will be deprived of the oxygen they require to work.

People who are otherwise severely ill or have major injuries are more likely to develop ARDS. The clear indicator of ARDS is severe breathlessness, which appears anywhere from a few moments to a few days after the triggering event or infection. Most individuals who get ARDS do not even survive through. With increasing age and severity of illness, the probability of death doubles. Some patients who survive ARDS recover entirely, and many have their lungs irreparably destroyed.

Most people who develop ARDS have already been admitted to the hospital due to trauma or disease. ARDS can be life-threatening and can swiftly deteriorate. However, it is usually manageable, and the majority of patients improve. It's critical to have a quick evaluation and management.

Causes

Fluid leaks from the lungs' smallest blood channels into the tiny air sacs where gaseous exchange takes place, which is the mechanical reason of ARDS. This fluid is normally kept in vessels by a barrier. However, serious disease or injury can harm the membrane, resulting in a fluid leak.

The following are some of the most significant risk factors for the development of ARDS: 

  • Sepsis, a common and severe infection of the bloodstream, is the most likely source of ARDS.
  • Hazardous compounds inhalation
  • Influenza virus pneumonia 
  • Pancreatitis
  • Half drowning
  • Injury to the head, chest, or other body parts
  • Transfusions of blood
  • Recent high-risk surgery or chemotherapy

Risk Factors And Epidemiology

 Doctors are baffled as to why some people develop ARDS while others do not. Factors that increase your risk to get ARDS are as follows:

  • You have a genetic condition
  • Consuming a lot of wine
  • Tobacco smoking
  • Taking oxygen to treat a lung problem.
  • Obesity

The death rate of ARDS varies depending on the extent of the disease; for mild, moderate, and severe diseases, the rates are 27 percent, 32 percent, and 45 percent, respectively.

The number of patients with ARDS varies substantially depending on where they live. Even though the cause of the variations is unknown, some have argued that it could be due to inequalities in healthcare systems. It is necessary to diagnose and differentiate the secondary ailment for better management.

Signs And Symptoms

 The severity of clinical manifestations of ARDS varies depending on the etiology and severity of the condition, as well as the degree of underlying cardiac or respiratory illness. They are as follows:

  • Difficulty breathing
  • Breathing that is difficult and rapid
  • Blood pressure that is too low
  • Irritability and exhaustion
  • Breathing that is difficult and fast
  • Tiredness and a general feeling of weakness
  • Skin or fingernails that are darkened
  • A temperature, headaches, a dry, persistent cough
  • An increased pulse rate
  • Disorientation

Diagnosis

ARDS is a life-threatening emergency, and early detection could help patients live longer.

ARDS can be diagnosed in a variety of ways by a clinician. No one test can be used to diagnose this illness. The doctor may recommend a blood pressure measurement, clinical history,  examination findings, and any of the following tests.

Imaging: An X-ray of your lungs can show which sections of your lungs are involved and how much of your lungs have fluid in them, as well as whether your heart is swollen. A chest CT scan provides extensive data on the heart and lungs anatomy. It is more sensitive to detect pulmonary infiltrates and pneumothoraces (air in the lung).

Blood tests: Your oxygen level is determined using blood from an artery in your forearm. Other blood tests might be used to look for evidence of infection. If your doctor thinks you have a respiratory infection, they may test secretions from your lungs to identify the source of the infection. E.g., Swabs of the throat and nose.

Other tests: Because the clinical manifestations of ARDS are identical to those of other heart conditions, your doctor may order a series of heart tests, including:

BNP levels: BNP is a protein released by a failing heart. BNP levels are increased in heart failure.  A BNP level of less than 100 pg/mL suggests ARDS instead of pulmonary edema due to heart failure in a person with bilateral infiltrates and hypoxemia. 

Electrocardiogram: This non-invasive examination monitors your heart's electrical activity.

Echocardiogram: This test, which is ultrasonography of the heart, can show abnormalities with the function and structure of your heart.

Management

There is no medicine to prevent the development of ARDS Or to cure it. The condition is managed by a multidisciplinary approach. 

The fundamental components of initial care include early vigorous resuscitation for accompanying circulatory collapse and its related distal organ impairment. The primary illness must be searched for and treated first, followed by supportive therapy, careful fluid management, noninvasive or artificial ventilation.

Medications and Supportive Care

Antibiotic therapy: Since infection is frequently the root cause of ARDS, prompt delivery of adequate antibiotic medication broader enough to cover suspected pathogen and thorough examination of the patient to establish potential infection sources is critical. As sepsis-associated ARDS may not improve without such therapy, it may be necessary to remove intravascular lines, drain infected fluid collections, or surgical exfoliation or excision of an infected site. 

Corticosteroids such as Methylprednisolone in patients who have persistent pulmonary infiltrates and fever despite resolution of infection. 

Fluid Control: To achieve a negative fluid balance, closely monitor urinary output and provide diuretics. Hemodialysis with ultrafiltration may be recommended in oliguric patients.

Ventilation: A patient may be needed to be supplemented with artificial ventilation.

General Care: Deep Vein Thrombosis (DVT) prevention, ambulation, repositioning and skincare, stress ulcers assessment, and techniques to avoid ventilator-induced infections, such as elevating the head of the bed and using a subglottic vacuum device.

Prognosis

It may take quite a long time to recover from ARDS. A few people recover completely, while others may suffer serious lung difficulties that necessitate the attention of a lung specialist (pulmonologists). Post-intensive care syndrome (PICS) can occur in some individuals, result in post-traumatic stress disorder, extreme tiredness, worry, and despair.

Lifestyle Modifications

  • After discharge from the hospital, make sure you have help with everyday duties until you understand what you can handle on your own.
  • Individuals with persistent lung disorders might join support networks. Find out what's accessible in your area, and try to join a group of others who have had similar struggles.
  • If you smoke, get assistance to quit and avoid passive smoking as much as feasible.
  • The flu vaccine and the pneumonia vaccine can help you avoid chest infections.
  • Many medical facilities now offer pulmonary rehabilitation programs, including fitness training, teaching, and counseling to help you regain your usual tasks and reach your desired weight.