Acute respiratory distress syndrome

Acute respiratory distress syndrome, or ARDS, is an inflammatory lung injury that happens when fluids build up in small air sacs (called alveoli) in the lungs. ARDS prevents the lungs from filling up with air and causes dangerously low oxygen levels in the blood (hypoxemia).

This condition prevents other organs such as brain, heart, kidneys and stomach from getting the oxygen they need to function. ARDS is dangerous and can lead to a number of serious and life-threatening problems.

ARDS typically happens in hospital settings while the patient is being treated for infection or trauma. If you’re not hospitalized and experience symptoms of ARDS, get medical attention immediately.

ARDS may develop over a few days, or it can get worse very quickly. The first symptom of ARDS is usually shortness of breath. Other symptoms of ARDS are low blood oxygen, rapid breathing, and clicking, bubbling, or rattling sounds in the lungs when breathing. ARDS can develop at any age.

Severe shortness of breath or breathlessness.

Rapid and labored breathing.

Extreme tiredness and muscle fatigue.

Confusion.

Rapid heart rate.

Bluish color of fingernails and lips due to low oxygen level in the blood.

Cough and chest pain.

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.

Underlying causes of ARDS include:

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.

Most people who develop ARDS are already hospitalized for another condition, and many are critically ill. You're especially at risk if you have a widespread infection in your bloodstream (sepsis).

People who have a history of chronic alcoholism are at higher risk of developing ARDS. They're also more likely to die of ARDS.

Acute respiratory distress syndrome (ARDS) is a disease associated with both short- and long-term complications. Acute complications include refractory respiratory failure requiring prolonged dependence on mechanical ventilation and the subsequent need for tracheostomy and gastrostomy tubes, protracted immobilization, and lengthy stays in the intensive care unit resulting in delirium, critical illness myopathy, and polyneuropathy, as well as secondary nosocomial infections. Chronic adverse outcomes of ARDS include irreversible changes such as fibrosis, tracheal stenosis from prolonged tracheostomy tube placement, pulmonary function decline, cognitive impairment and memory loss, posttraumatic stress disorder, depression, anxiety, muscle weakness, ambulatory dysfunction, and an overall poor quality of life. The degree of disability in ARDS survivors is heterogeneous and can be evident even years after hospitalization. Although survival rates have improved over the past 4 decades, mortality remains significant with rates reported as high as 40%. Despite advancements in management, the causes of death in ARDS have remained relatively unchanged since the 1980s with sepsis/septic shock and multiorgan failure at the top of the list.

What are the complications of respiratory distress syndrome?

Bleeding in the brain, which can delay cognitive development or cause intellectual disabilities or cerebral palsy. Lung complications, such as air leaking from the lung into the chest cavity, called pneumothorax, or bleeding in the lungs. Impaired vision. Infections that can cause sepsis.

Blood clots or deep vein thrombosis.

Collapsed lung (pneumothorax). ...

Confusion (delirium).

Muscle weakness.

Scarred lungs or lung fibrosis.

Post traumatic stress disorder (PTSD).

Anxiety and depression.

The paucity of effective therapeutic interventions in patients with the acute respiratory distress syndrome (ARDS) combined with overwhelming evidence on the importance of timely implementation of effective therapies to the critically ill patients have resulted in a recent shift in ARDS research. Increasingly, efforts are being directed towards early identification of patients at risk with a goal of prevention and early treatment, prior to development of the fully established syndrome. The focus of this review is on the prevention of ARDS in patients without this condition at the time of their healthcare encounter.

The primary thematic categories presented in this review article include: Early identification of patients at risk of developing ARDS, optimization of care delivery and its impact on the incidence of ARDS, pharmacological prevention of ARDS, prevention of postoperative ARDS, and challenges and opportunities with ARDS prevention studies.

Recent improvements in clinical care delivery have been associated with a decrease in the incidence of hospital acquired ARDS. Despite the initial challenges, research in ARDS prevention has become increasingly feasible with several randomized controlled trials on ARDS prevention completed or on the way.