Adult Respiratory Distress Syndrome (ARDS)

Respiratory Conditions ~ Adult Respiratory Distress Syndrome (ARDS)

ARDS is an extremely serious lung disorder that can result from a number of direct and indirect causes. ARDS may also be referred to as Acute Lung Injury (ALI).

What does the Respiratory System do ?

The respiratory system consists of the lungs, airways and blood vessels. The function of the respiratory system is to absorb oxygen into the body and to remove carbon dioxide from the body. A normal breath requires a complex coordination between the nervous system (brain & spinal cord) and the muscles of breathing (including the diaphragm and muscles between the ribs).

Abnormal and or inadequate breathing can occur as a result of:

• An interruption to the nervous system (head injuries or spinal injuries for example)
• Barriers to the absorption of oxygen (eg fluid in the alveoli);
• Obstruction to the flow of gases through the lungs, both breathing in or out (eg asthma);
• Damage to the rib cage (in motor vehicle trauma for example);
• Pain, which makes taking a normal breath difficult.

There are many respiratory conditions which if not treated can result in respiratory failure and require the patient to be admitted to a high dependency or intensive care unit for further monitoring and ventilation support (help with breathing). This support may be through the use of oxygen masks, CPAP or via a breathing tube(endotracheal tube) and ventilator (breathing machine).

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ARDS- what happens?

ARDS is an extremely serious lung disorder that can result from a number of direct and indirect causes. Another similar term used may be ‘acute lung injury’. The direct causes include lung contusion (bruising), as a consequence of an accident, severe pneumonia or inhalation of stomach contents (aspiration). Indirect causes include severe infections, massive blood transfusion (more than 15 units of blood in a very short period), acute pancreatitis, severe trauma or burns. These insults can trigger a series of events that lead to the leakage of fluid from the blood vessels into the alveoli. The lungs become oedematous (water logged) and so performing their basic function of absorbing oxygen can become almost impossible. The deterioration in lung function can occur very quickly over a number of hours or more slowly over a couple of days.

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What happens in intensive care?

Patients can be admitted to an intensive care because it is thought they have or may be developing ARDS or they may already be a patient for other reasons. The treatment for ARDS revolves around supporting the lungs until they can repair themselves. Full ventilation using a ventilator (breathing machine) and an endotracheal tube (breathing tube) will usually be required to improve the oxygen delivery. Close monitoring using a bedside monitor, an arterial line and a saturation monitor will be done. You can expect the patient to have frequent chest x-rays and blood tests especially arterial blood gases (ABGs). Use of a pulmonary artery catheter or a PICCO catheter to closely monitor cardiac function is not uncommon. Under extreme circumstances where oxygen uptake cannot be improved alternative treatments such as ECMO or procedures such as or prone ventilation may be considered.

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How long will the patient remain in Intensive Care?

Patient prognosis and length of stay in intensive care is linked to the severity of lung injury, failure of other organs (especially the kidneys, heart and brain) and infection. Despite aggressive treatment 35% of patients will die and the prognosis remains guarded so long as ventilator support is still required. Insertion of a tracheostomy tube may become necessary as the length of breathing support exceeds 7-10 days. For those patients who do survive recovery of lung function is normally good although it can take a long time.

The information contained on this page is general in nature and therefore cannot reflect individual patient variation. In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.

ARDS ~ Version 1 (Authors C Inness & K Rolls)