Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome

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Overview

It is a severe lung condition which occurs when fluid fills up the tiny air sacs (alveoli) in the lungs. This deprives the organs of the oxygen supply which is essential for their functioning. Long term oxygen deprivation can lead to organ failure. 

What is acute respiratory distress syndrome (ARDS)?

The fluid interferes with the entry of air in the lungs and reduces the amount of oxygen entering the bloodstream.

ARDS most commonly affects hospitalized patients and those who are critically ill. Symptoms usually occur a few days after the trauma or infection. ARDS is a medical emergency and requires prompt medical treatment. The risk of death (mortality) increases with age and severity of infection.

What are the symptoms of ARDS?

Common symptoms of ARDS include-

  • Severe shortness of breath
  • Rapid and shallow breathing
  • Chest pain
  • Muscle fatigue (tiredness)
  • General body weakness
  • Low blood pressure
  • Bluish discoloration of skin or nails
  • Dry cough
  • Fever
  • Headaches
  • Mental confusion

What are the causes of ARDS?

  • Sepsis (infection of the blood stream)
  • inhaling toxic substances, such as fumes, chemicals, salt water, smoke, and vomit
  • Severe pneumonia
  • Severe pancreatitis (infection of pancreas)
  • Severe covid 19 (coronavirus infection)
  • Direct injury to the head or chest due to road traffic accident, fall or during contact sports
  • Overdose of sedatives (sleep inducing drugs) or anti-depressant medicines

What are the risk factors of ARDS?

Individuals who fall under following category are at an increased risk of developing ARDS

  • Elderly patients especially those above 65 years
  • History of tobacco use, cigarette smoking
  • History of alcohol abuse
  • Obesity
  • Patients who have undergone high-risk surgeries
  • Patients with liver failure
  • Patients with chronic lung disease

How is ARDS diagnosed ?

ARDS is a potential life-threatening situation and early diagnosis improves the chances of survival. The cardinal features of the condition are low blood pressure and low oxygen saturation; therefore, your doctor will first measure these parameters. He/she will also perform a thorough physical examination and look for signs of oxygen desaturation such as bluish discoloration of nails and/or lips. To confirm the diagnosis, your doctor may recommend you to undergo any of the following tests-

  • Blood tests: this test will provide information about blood cell count (red blood cells, white blood cells, lymphocytes etc). First signs of sepsis (blood infection) and anaemia can be easily identified with the help of a blood test.
  • Chest X ray: in this test small amounts of radiations are used to create an image of the airways and the lungs. A chest x-ray is helpful in identifying any structural abnormalities of the airways.
  • Chest CT scan: in this test series x-rays are used to create a cross sectional detailed image of the lungs. It is helpful in identifying any soft tissue abnormalities of the airways. Chest infections such as pneumonia and other chronic lung conditions such as COPD, emphysema, bronchiectasis etc can be diagnosed on a CT scan.
  • Electrocardiogram: small plastic patches are glued at specific spots over chest and arm to record the electrical activity of the heart. The leads are either connected to a monitor or a printer that convert the signals into a rhythmic wave.
  • Echocardiogram: it is an ultrasound scan of the heart which provides a clear picture of the inside of the heart and nearby blood vessels. During this procedure a small probe that emits high frequency sound waves is placed over the chest. These sound waves can easily travel through the skin and muscles. Once they reach the target organ, these are then reflected back and create a live visual image of how the heart is functioning.

How is ARDS treated ?

There is no definite cure available for ARDS. The treatment aims at providing symptomatic relief to the patients and prevents worsening of the condition. The four main pillars of ARDS treatment are-

  • Maintaining oxygen saturation: The primary goal of the treatment is to improve the level of oxygen in the bloodstream, so that different organs of the body can function properly. In patients with mild symptoms, a face mask can be used to deliver oxygen, while in severe cases a ventilator will be used. A ventilator pushes oxygen rich air into the lungs and forces fluid out of the air sacs.
  • Patient positioning: studies have shown that lying on the stomach, also known as proning is quite helpful in increasing blood oxygen saturation. But, it is often a complicated task for critically ill patients and they require assistance for doing so.
  • Fluid management: it is important to carefully monitor the fluid intake of the body, as too much fluid can increase the fluid build up in the lungs, while too little fluid intake may lead to dehydration and again affect functioning of heart and other organs of the body.
  • Medications: your doctor will prescribe antibiotic medicines to treat infections, pain relieving medicines, blood pressure medicines, blood thinners, and if required sleep inducing medicines (sedatives) to comfort the patient. Certain medications may cause unpleasant side effects and it is therefore important to inform your doctor in case you experience anything unusual.

What is pulmonary rehabilitation?

Patients recovering from ARDS will be advised to undergo pulmonary rehabilitation. This is usually done by a respiratory therapist or a physical therapist specialising in respiratory disease management. The program consists of several breathing exercises, simple exercises of upper extremities (shoulder and arms) and some aerobic exercises. The rehabilitation program will be customized depending on the severity of disease and overall health of the patient.

The therapy aims at strengthening the respiratory muscles and increasing the lung capacities. Your therapist will also educate and counsel you about your condition and suggest coping strategies on how to effectively recover from ARDS.

What are the complications of ARDS?

  • Collapse of a part of the lung (atelectasis)
  • Air getting trapped between lung and chest wall (pneumothorax), may be due to pressure applied by the ventilator on the damaged lung
  • High blood pressure in the artery that carries blood from heart to the lungs (pulmonary hypertension)
  • Scarred lung tissue (pulmonary fibrosis)
  • Sepsis (blood infection)
  • Confusion (delirium)
  • Scarring of lungs (lung fibrosis)
  • Post traumatic stress disorder (PTSD)
  • Anxiety and depression.
  • Blood clots
  • Blood clots in deep veins (deep vein thrombosis)
  • Organ damage or failure

Tips for healthy lungs

If you're recovering from ARDS, the following suggestions will protect your lungs and fasten the recovery:

  • Seek immediate medical attention for any trauma, infection, or illness.
  • Quit smoking and stay away from second hand smoke.
  • Give up alcohol. Chronic alcohol use affects lung function and increases the risk of developing ARDS.
  • Get the annual flu vaccine and pneumonia vaccine every five years. This decreases the risk of lung infections.

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