| Adult respiratory distress syndrome (ARDS) is the rapid onset of progressive respiratory failure caused by severe swelling in the lungs (pulmonary interstitial and alveolar edema) and diffuse alveolar damage, which usually develops within 2 to 4 days after an initiating trauma or illness. It is usually associated with other severe illnesses and the malfunction of other organs. It may also result from receiving high percentages of oxygen delivered over extended periods of time (oxygen toxicity).
The condition is characterized by extensive lung inflammation and the abnormal accumulation of fluid in the lung tissue that is not associated with heart problems (noncardiogenic pulmonary edema), respiratory distress, pulmonary contusion, fat embolization, or inadequate oxygenation of the blood (hypoxemia).
ARDS may be precipitated by a variety of acute processes that either directly or indirectly injure the lung, such as trauma, an infection in the blood (sepsis), bacterial or viral pneumonia, a drug overdose, aspiration of gastric contents, acute hemorrhagic pancreatitis, inhalation of smoke or other toxic fumes, nearly drowning, shock and may be associated with extensive surgery and certain blood abnormalities.
The survival rate for ARDS has risen from about 40% to about 70% for those who receive good care ("ARDS"). The rate varies based on the individual's age and health and the severity of the condition causing the distress. It is a common problem in hospital intensive care units.Risk: ARDS can occur in people with or without a previous lung disease, usually during treatment for another serious illness or a major injury. A serious injury that results in a large amount of blood loss also puts people at higher risk of ARDS. Cigarette smoking is thought to increase the risk of ARDS. Incidence and Prevalence: About 150,000 cases of ARDS occur in the US each year ("ARDS"). |
Source: Medical Disability Advisor
| History: Individuals with ARDS complain of difficulty breathing (dyspnea). ARDS can follow a wide variety of pulmonary or nonpulmonary insults; other symptoms, if present, are usually related to the predisposing condition. Physical exam: The exam findings are not disease-specific for ARDS and include mottled or bluish complexion (cyanosis) due to decreased oxygen levels in the circulating blood, moist skin, labored breathing, excessively rapid shallow breathing (tachypnea), excessively rapid heartbeat (tachycardia), agitation, and lethargy followed by clouding of consciousness (obtundation). Listening with a stethoscope (auscultation) may detect crackles, rhonchi, or wheezes. Tests: Lab studies will include a complete blood count (CBC), sputum cultures, and arterial blood gases (ABGs). Chest x-rays will be taken to check for the presence of infiltrates in both (bilateral) lungs. A pulmonary artery catheter may be placed. The classic series of tests to confirm a diagnosis of ARDS is a pulmonary arterial wedge pressure (PAWP), an alveolar oxygen pressure (PaO2), and a fraction of inspired oxygen (FiO2). |
Source: Medical Disability Advisor
| Oxygenation must be maintained while the underlying cause of the lung injury is identified and corrected. Passing a tube (intubation) through the nose or mouth (endotracheal tube, or ETT) into the trachea is often required. Ventilation (respirator) or supportive breathing (positive end expiratory pressure, or PEEP) is usually necessary to support the damaged respiratory system. Severe cases may be treated with cardiopulmonary bypass. Medications (antibiotics, antivirals, and antifungals) may be needed to treat infections. In addition, pain relievers and muscle relaxants may help reduce movement, thereby decreasing the body’s demand for oxygen. Management includes prevention of nutritional depletion, oxygen toxicity, superinfection, and renal failure. |
Source: Medical Disability Advisor
| The death rate for adult respiratory distress syndrome is approximately 30% (Kotton). Nonsurvivors usually succumb to sepsis or multiple organ system failure. The death rate is proportionate to the number of failed organ systems. With four or more (including the lung), mortality is near 100%. Individuals who survive usually recover normal lung function with minimal, if any, persistent pulmonary symptoms. Those who survive severe cases may suffer permanent pulmonary fibrosis, restrictive lung disease, or cognitive effects such as memory loss, which is thought to result from hypoxia. |
Source: Medical Disability Advisor
| Possible complications of this condition include tension pneumothorax, pneumonia obtained from mechanical ventilation (ventilator-assisted pneumonia), secondary bacterial superinfection of the lungs, and multiple organ system failure (especially renal failure). Cardiovascular or renal problems may affect the individual's ability to recover and may further lengthen disability. |
Source: Medical Disability Advisor
| It is important to avoid smoke, fumes, dust, and any other irritant that could be inhaled while recovering from ARDS. Proper ventilation, masks, or respirators may be necessary. Inhaling extremely hot or extremely cold air can also trigger recurrence of symptoms. If the individual suffers from shortness of breath, a temporary or permanent reduction in the job's physical demands may be needed. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have difficulty breathing (dyspnea)?
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Although not disease-specific for ARDS, does individual have mottled or bluish complexion (cyanosis) due to decreased oxygen levels in the circulating blood, moist skin, labored breathing, excessively rapid shallow breathing (tachypnea), excessively rapid heartbeat (tachycardia), agitation, and lethargy followed by clouding of consciousness (obtundation)?
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Were sputum culture and arterial blood gases (ABGs) done? Was chest x-ray done? Were a pulmonary arterial wedge pressure (PAWP), an alveolar oxygen pressure (PaO2), and a fraction of inspired oxygen (FiO2) performed?
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Was diagnosis of adult respiratory distress syndrome confirmed?
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Were conditions with similar symptoms ruled out? Are sequelae (such as asthma) present?
Regarding treatment:
- Has underlying cause of lung injury been identified? Is it responding to treatment?
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Were medications (antibiotics, antivirals, antifungals, corticosteroids) successful in resolving infection and reducing inflammation?
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Was culture and sensitivity done to identify the causative organism and determine the most effective medication?
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Were antibiotic-resistant organisms ruled out?
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If mechanical ventilation (respirator) or supportive breathing (positive end expiratory pressure, or PEEP) was necessary to support the damaged respiratory system, did complications occur when it was time to wean individual off the machine?
Regarding prognosis:
- Has normal lung function returned? Does individual have any residual pulmonary impairment?
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If condition was severe, was there permanent pulmonary fibrosis or restrictive lung disease? What impact does this have on individual's ability to function?
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Did complications develop, such as tension pneumothorax, secondary bacterial superinfection of the lungs, or multiple organ system failure?
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Source: Medical Disability Advisor
| "ARDS (Acute Respiratory Distress Syndrome)." MedlinePlus. National Library of Medicine. 15 Sep. 2004 <http://www.nlm.nih.gov/medlineplus/ency/article/000103.htm#Expectations%20(prognosis)>.Kotton, Darrell N. "Disease - ARDS." drgreene.com. A.D.A.M., Inc. 28 Apr. 2005 <http://www.drgreene.org/body.cfm?id=49&action=Display&articlenum=103>. |
Source: Medical Disability Advisor
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