ARDS

Description

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.
Many people who develop ARDS don’t survive.

Symptoms for ARDS

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.
Acute respiratory distress syndrome (ARDS) is a condition that causes fluid to build up in your lungs so oxygen can’t get to your organs.

Fluid leaks from small blood vessels and collects in tiny air sacs in your lungs so they can’t fill with enough air. Because of this, yourblood can’t pick up the oxygen it needs to carry to the rest of your body. Organs such as your kidneys or brain might not work the way they should or might shut down.

The signs and symptoms of ARDS can vary in intensity, depending on its cause and severity, as well as the presence of underlying heart or lung disease. They include:
• Severe shortness of breath
• Labored and unusually rapid breathing
• Low blood pressure
• Confusion and extreme tiredness

Causes of ARDS

The mechanical cause of ARDS is fluid leaked from the smallest blood vessels in the lungs into the tiny air sacs where blood is oxygenated. Normally, a protective membrane keeps this fluid in the vessels. Severe illness or injury, however, can cause damage to the membrane, leading to the fluid leakage of ARDS.
Sepsis. The most common cause of ARDS is sepsis, a serious and widespread infection of the bloodstream.
• Inhalation of harmful substances. Breathing high concentrations of smoke or chemical fumes can result in ARDS, as can inhaling (aspirating) vomit or near-drowning episodes.
Severe pneumonia. Severe cases of pneumonia usually affect all five lobes of the lungs.
Head, chest or other major injury. Accidents, such as falls or car crashes, can directly damage the lungs or the portion of the brain that controls breathing.
• Coronavirus disease 2019 (COVID-19). People who have severe COVID-19 may develop ARDS.
• Others. Pancreatitis (inflammation of the pancreas), massive blood transfusions and burns.

Diagnosis

There’s no specific test to identify ARDS. The diagnosis is based on the physical exam, chest X-ray and oxygen levels. It’s also important to rule out other diseases and conditions — for example, certain heart problems — that can produce similar symptoms.
Imaging
• Chest X-ray. A chest X-ray can reveal which parts of your lungs and how much of the lungs have fluid in them and whether your heart is enlarged.
• Computerized tomography (CT). A CT scan combines X-ray images taken from many different directions into cross-sectional views of internal organs. CT scans can provide detailed information about the structures within the heart and lungs.
• Lab tests. A test using blood from an artery in your wrist can measure your oxygen level. Other types of blood tests can check for signs of infection or anemia.

Treatment

The first goal in treating ARDS is to improve the levels of oxygen in your blood. Without oxygen, your organs can’t function properly.
Oxygen
To get more oxygen into your bloodstream, your doctor will likely use:
• Supplemental oxygen. For milder symptoms or as a temporary measure, oxygen may be delivered through a mask that fits tightly over your nose and mouth.
• Mechanical ventilation. Most people with ARDS will need the help of a machine to breathe. A mechanical ventilator pushes air into your lungs and forces some of the fluid out of the air sacs.
• The goal of treatment for ARDS is to improve oxygen levels and treat the underlying cause. Other treatments aim to prevent complications and make you comfortable.
• Fluids. Carefully managing the amount of intravenous fluids is crucial. Too much fluid can increase fluid buildup in the lungs. Too little fluid can put a strain on your heart and other organs and lead to shock.
• Medication.
• People with ARDS usually are given medication to:
• Prevent and treat infections
• Relieve pain and discomfort

Complications

If you have ARDS, you can develop other medical problems while in the hospital. The most common problems are:
• Blood clots. Lying still in the hospital while you’re on a ventilator can increase your risk of developing blood clots, particularly in the deep veins in your legs. If a clot forms in your leg, a portion of it can break off and travel to one or both of your lungs (pulmonary embolism) — where it blocks blood flow.
• Collapsed lung (pneumothorax). In most ARDS cases, a breathing machine called a ventilator is used to increase oxygen in the body and force fluid out of the lungs. However, the pressure and air volume of the ventilator can force gas to go through a small hole in the very outside of a lung and cause that lung to collapse.
• Infections. Because the ventilator is attached directly to a tube inserted in your windpipe, this makes it much easier for germs to infect and further injure your lungs.

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