Outlines

• Introduction
 Introduction

• Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the
tiny, elastic air sacs (alveoli) in lungs.

• The fluid keeps lungs from filling with enough air, which means less oxygen
reaches bloodstream. This deprives organs of the oxygen they need to function.

• ARDS typically occurs in people who are already critically ill or who have
significant injuries.

• Severe shortness of breath — the main symptom of ARDS — usually develops

within a few hours to a few days after the precipitating injury or infection.
 Inroduction Cont’D

• Many people who develop ARDS don't survive.

• The risk of death increases with age and severity of illness.

• Of the people who do survive ARDS, some recover completely while others
experience lasting damage to their lungs.

• ARDS usually follows a major illness or injury, and most people who are affected
are already hospitalized.
 Causes
ARDS can be caused by any major direct or indirect injury to the lung. Common causes
include:

A. Conditions that cause direct lung injury include:

• Pneumonia

• Aspiration (inhalation of stomach contents into the lungs)

• Inhalation of toxic substances

• Bruising of the lungs caused by chest trauma

 Cause of ARDS Cnnt’D

• Near-drowning

• Fat embolism (when a clot of fat enters the pulmonary circulation)

• Lung transplantation

• Viral infection of the lungs, including by SARS-CoV-2, the coronavirus that

causes COVID-19 infection.
 Cause of ARDS Cnnt’D
B. Conditions that cause indirect lung injury include:

1. Sepsis (the body’s overreaction to an infection that can damage multiple

organ systems, including the lungs)
2. Severe trauma to the body (head trauma, burns, multiple bone fractures)
3. Massive blood transfusion
4. Pancreatitis (inflammation of the pancreas)
5. Cardiopulmonary bypass (heart-lung bypass surgery)
6. Drug overdose
7. Out of these possible causes of lung injury, two of them—sepsis and
pneumonia—make up 40% to 60% of all ARDS cases.
 Symptoms
• Symptoms usually develop within 24 to 48 hours of the injury or illness. Often,
people with ARDS are so sick they cannot complain of symptoms.

• Symptoms can include any of the following

Severe shortness of breath

Labored and unusually rapid breathing

Low blood pressure

Confusion and extreme tiredness

Fast heartbeat

 Organ failure
 Severity Classification of ARDS
Depending on the amount of oxygen in the blood and during breathing, the severity
of ARDS is classified as
• Mild
• Moderate
• Severe
 Risk factors
 Infection

• The most common are flu or other virus , such as respiratory syncytial virus and

• SARS-CoV-2, the virus responsible for COVID-19.

• Pneumonia

• Sepsis , a condition in which bacteria infect the bloodstream

• Uterine infection in the mother, affecting a newborn’s lungs

 Environment

• Being exposed to air pollution for weeks or months can make you more vulnerable to ARDS.
Lifestyle habits
Habits that harm the health of your lungs increase your risk of ARDS.
These include:
• Heavy alcohol use
• Overdose of illegal drugs
• Smoking
Family history and genetics
Other medical conditions or procedures can raise the risk for ARDS. These may
include:
• Inhaling vomit, smoke, chemical fumes, or water during a near drowning

• Injury: An injury from a blow, burn, or broken bone can lead to ARDS. A broken bone, for
example, can lead to a fat embolism, a clot of fat that blocks an artery .
• Lung or heart surgery or being placed on a heart-lung bypass machine or ventilator

• Pancreatitis, a condition in which the pancreas (a gland that releases enzyme and
hormones ) becomes infected
• Reaction to medicines, such as those used to treat cancer or arrhythmia
 History and Physical examination
History taking
Symptoms may vary in severity, with some being mild initially; all worsen over a
period of several hours
• Dyspnea

• Cough

• Chest discomfort

• Anxiety
 Physical Examination
• Cyanosis may be evident

• Tachypnea at rest

• Tachycardia at rest

• Hypotension is often present

• Fever may or may not be present,

• Use of accessory muscles of respiration (usually indicates moderate to severe disease)

• Coarse crepitations of both lungs at presentation

• Cold, mottled extremities with prolonged capillary refill time (longer than 2 seconds)
indicates ineffective circulation
 DIAGNOSTIC PROCEDURES

PRIMARY DIAGNOSTIC TOOLS

Use history, physical examination findings, arterial blood gas measurements, and
imaging studies

• Chest radiography is the initial diagnostic evaluation

• CT is not routine but is often obtained for more detail

• Echocardiography helps to differentiat early from cardiogenic pulmonary edema

Diagnosis Cont...
LABORATORY
• Routine laboratory tests include CBC, blood chemistries, and
coagulation studie
• Sputum Gram stain and culture
• Serum amylase or lipase if acute pancreatitis is suspected
• Consider COVID-19 testing for patients who are at risk
• Arterial blood gas measurement findings which include:
 Varying degrees of hypoxemia
 Earliest finding is respiratory alkalosis; with progression, respiratory acidosis
with hypercapnia
 Widened alveolar-arterial gradient
 ARDS Treatment
Treatment for ARDS typically aims to increase blood oxygen levels, provide
breathing support, and treat the underlying cause of the disease.
Oxygen and Ventilation.
• Most ARDS patients are placed on a mechanical ventilator, usually in the intensive care
unit of a hospital.
Medications to manage symptoms.
• Often patients are given diuretics to help clear away excess fluid buildup in the lungs,
and pain medication to relieve discomfort.
Treating underlying cause.
• In addition to increasing blood oxygen levels, doctors must treat the underlying medical
condition that led to ARDS.
Prone positioning.
• For ARDS in general and especially with COVID-19, having a patient lie on their belly (on
or off a ventilator) can help patients use parts of their lungs that aren’t used when lying
on their back.
 Initial Ventilator Management in ARDS
Generally, the following approach is recommended for ventilator management in
ARDS:
• Assist-control mode is used initially with a tidal volume 6 mL/kg ideal body weight,
respiratory rate 25/minute, flow rate 60 L/minute, FIO2 1.0, and PEEP 15 cm H2O.
• Once oxygen saturation is > 90%, FIO2 is decreased.
• hen, PEEP is decreased in 2.5-cm H2O increments as tolerated to find the least PEEP
associated with an arterial oxygen saturation of 90% on an FIO2 of ≤ 0.6.
• The respiratory rate is increased up to 35/minute to achieve a pH of > 7.15, or until
the expiratory flow tracing shows end-expiratory flow.
• Ideal body weight (IBW) rather than actual body weight is used to determine the
appropriate tidal volume for patients with lung disease receiving mechanical
ventilation:
equation
Mechanical ventilator algorism for ARDS
 Criteria of Success or Failure of Spontaneous Breathing Trial
(SBT).
Failure of a Spontaneous Breathing Trial
Successful Spontaneous Breathing Trials
• Respiratory rate > 35 breaths/min
• Respiratory rate < 35 breaths/min
• Heart rate < 140/min or heart rate variability • Use of accessory muscles
of > 20% • Dyspnea
• Arterial oxygen saturation > 90% or PaO2 > • Asynchronous movement of the
60 mmHg on FiO2 < 40% abdomen and rib cage
• 80 < Systolic blood pressure < 180 mmHg or < • SpO2 < 90%
20% change from baseline
• Heart rate> 140/min or sustained 20%
• No signs of increased work of breathing or
distress increase in heart rate
• Good tolerance to spontaneous breathing trial • Systolic blood pressure > 180 mmHg
and diastolic > 90 mmHg
• Anxiety, Diaphoresis
 Complications
Possible Complications that result from ARDS or its treatment include:
• Failure of many organ systems
• Lung damage, such as a collapsed lung (also called pneumothorax) due to
injury from the breathing machine needed to treat the disease
• Pulmonary fibrosis (scarring of the lung)
• Ventilator-associated pneumonia
 References
1. Penn Medicine 2023. Acute Respiratory Distress Syndrome (ARDS)
https://www.pennmedicine.org/
2. Yale Medicine (2023) Acute Respiratory Distress Syndrome (ARDS)
https://www.yalemedicine.org/conditions/ards
3. https://elsevier.health/en-US/preview/ards-in-adults#reference-1
4. Aldabayan YS, Tolba AA, Alrajeh AM, Ahmed AT, Mahgoub AA,
Glalah AA, Abdelhafez AI. Factors Affecting Mechanical Ventilator
Weaning Success and 28-Day Survival Among Patients With Acute
Respiratory Distress Syndrome Secondary to COVID-19. SAGE Open
Nursing. 2023 Jul;9:23779608231187248.
Thank You !!!