Acute Respiratory Distress

Syndrome
Acute Respiratory Distress Syndrome (ARDS)

• A form of acute respiratory failure that occurs

as a complication of some other condition; it is
caused by a diffuse lung injury and leads to
extravascular lung fluid.
• The major site of injury is the alveolar capillary
membrane.
• The interstitial edema causes compression and
obliteration of the terminal airways and leads to
reduced lung volume and compliance.
Acute Respiratory Distress Syndrome (ARDS)

• The ABG levels identify respiratory acidosis and

hypoxemia that do not respond to an increased
percentage of oxygen.
• The chest x-ray shows bilateral interstitial and alveolar
infiltrates; interstitial edema may not be noted until
there is a 30% increase in fluid content.
• Causes include sepsis, fluid overload, shock, trauma,
neurological injuries, burns, disseminated
intravascular coagulation, drug ingestion, aspiration,
and inhalation of toxic substances.
Acute Respiratory Distress Syndrome (ARDS)

Assessment Findings:
• Tachypnea
• Severe Dyspnea, use of accessory muscle
• Decreased breath sounds
• Severe crackles and rhonchi heard on auscultation
• Deteriorating ABG levels
• Hypoxemia despite high concentrations of delivered oxygen
• Decreased pulmonary compliance
• Pulmonary infiltrates
• Anxiety, restlessness
Acute Respiratory Distress Syndrome (ARDS)
Diagnostic Evaluation:
• The hallmark sign for ARDS is a shunt; hypoxemia remains despite increasing
oxygen therapy.
• Decreased lung compliance; increasing pressure required to ventilate patient on
mechanical ventilation
• Chest X-ray exhibits bilateral infiltrates (early stages). Lung fields with a ground-
glass appearance and, with irreversible hypoxemia, massive consolidation (“white-
outs”) of both lung fields (in later stages).
• Sputum reveals the infectious organism.
• Pulmonary artery catheter readings: pulmonary artery wedge pressure > 18mmHg.
• ABG analysis on room air initially shows a decreased PaO2 (less than 60mmHg) and
a decreased PaCO2 (less than 35mmHg). The resulting pH reflects respiratory
alkalosis.
• Blood culture reveals the infectious organism.
ABGs
Acute Respiratory Distress Syndrome (ARDS)
Nursing Diagnosis:
• Anxiety
• Impaired gas exchange
• Ineffective breathing pattern
• Ineffective tissue perfusion (cardiopulmonary)

Planning and Goals:

• Demonstrate improved oxygenation
• Demonstrate adequate breathing pattern
• Exhibit decreased anxiety

Nursing Evaluation: Expected Outcomes

• Adequate oxygenation
• Breathing without difficulty
• Decreased anxiety
Acute Respiratory Distress Syndrome (ARDS)

Treatment:
• Bed rest with prone position, if possible, and passive ROM
exercises.
• Rotating bed therapy.
• Chest physiotherapy, postural drainage, and suction.
• Restricted fluid intake or, if intubated, nothing by mouth.
• Extracorporeal membrane oxygenation, if available.
• Intubation and mechanical ventilation using PEEP or pressure-
controlled inverse ratio ventilation.
• Oxygen therapy.
• Transfusion therapy: platelets, packed RBCs.
Acute Respiratory Distress Syndrome (ARDS)
Treatment: Drug therapy options
• Analgesics: morphine sulfate
• Antacids: aluminum hydroxide
• Antibiotics: according to susceptibility of infecting organism
• Anticoagulants: heparin
• Diuretic: furosemide
• Exogenous surfactant: beractant
• Histamine-2 blockers: cimetidine, famotidine, ranitidine
• Mucosal barrier fortifier: sucralfate
• Neuromuscular blockers: pancuroniumbromide, vecuroniumbromide
• Proton pump inhibitor: pantoprazole sodium
• Steroids: hydrocortisone sodium succinate solu-cortef), methylprednisolone
sodium succinate (solu-Medrol)
Acute Respiratory Distress Syndrome (ARDS)

Nursing Interventions:
• Identify and treat the cause of the acute respiratory distress
syndrome.
• Administer oxygen as prescribed.
• Place the client in a Fowler’s position.
• Restrict fluid intake as prescribed.
• Provide respiratory treatments as prescribed.
• Administer diuretics, anticoagulants, or corticosteroids as
prescribed.
• Prepare the client for intubation and mechanical ventilation
using positive end-expiratory pressure (PEEP).