ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) ARDS, previously called adult respiratory distress syndrome, is sudden, life-threatening lung

failure. ARDS inflames the alveoli, causing them to fill with liquid and collapse. Once the alveoli collapse, gas exchange ceases, and the body becomes starved of oxygen. Etiologic Factors Related to ARDS Aspiration (gastric secretions, drowning, hydrocarbons) Drug ingestion and overdose Hematologic disorder (disseminated intravascular coagulopathy [DIC], massive transfusions, cardiopulmonary bypass) Prolonged inhalation of high concentrations of oxygen, smoke or corrosive substances Localized infection (bacterial, fungal, viral pneumonia) Metabolic disorders (pancreatitis, uremia) Shock (any cause) Trauma (pulmonary contusion, multiple fractures, head injury) Major surgery Fat or air embolism Systemic sepsis Signs and Symptoms Dyspnea (audible, labored breathing, shortness of breath) Tachypnea (abnormally rapid breathing) Severe hypoxemia (decreased oxygen concentration in the blood) Pulmonary hypertension (high blood pressure in the pulmonary arteries) Cyanosis (bluish discoloration of the skin due to poor oxygenation of the blood) Presence of abnormal deposits in the lungs (detected by chest x-rays)

Diagnosis ARDS is diagnosed primarily on the basis of the following clinical features:

Chest X-ray ABG Absence of clinical evidence of left atrial hypertension of other causes of diffuse pulmonary infiltrates (e.g., congestive heart failure, pulmonary hemorrhage) Abnormally low blood pressure in the pulmonary arteries
ACUTE LUNG INJURY Alveolar-capillary leak

Pathophysiology

Microvascular obstraction

Pulmonary edema Hyaline membrane Microatelectasis

Surfactant defect

V-Q mismatch Right-to-left shunt Pulmonary hyperventilation

Decrease compliance

HYPOXEMIA

DYSPNEA

^ dead space ^ minute ventilation

^ work of breathing

Management o Extra Oxygen o Medicines Many different kinds of medicines are used to treat ARDS patients. Some kinds of medicines often used include:

Antibiotics Pain relievers Drugs to relieve anxiety and keep the patient calm and from "fighting" the breathing machine Drugs to raise blood pressure or stimulate the heart Muscle relaxers

Complications of ARDS

Bacterial infections. Air leaks.

pneumothorax