ACUTE

RESPIRATORY
DISTRESS
SYNDROME
I. INTRODUCTION
ARDS
Acute respiratory distress
syndrome (ARDS; previously
called adult respiratory distress
syndrome) occurs when fluid
builds up in the tiny elastic air
sacs in your lungs. The fluid
keeps your lungs from filling
with enough air, which means
less oxygen reaches your
bloodstream. This deprives your
organs of the oxygen they need
to function.
 ARDS is an acute inflammation of
the lungs, caused by direct or
indirect injury, that leads to
pulmonary edema and hypoxemia.
Examples of direct lung injury
include pneumonia, lung trauma,
thoracic surgery, near-drowning, fat
emboli, and toxic gas inhalation.
Indirect injury can result from
complications such as sepsis,
multiple blood transfusion, burns,
cardiopulmonary bypass, non-
cardiogenic shock, and pancreatitis.
 The major site of injury is the
alveolar capillary membrane.

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.
ANATOMIC &
PHYSIOLOGIC OVERVIEW
The respiratory system is composed of
the upper and lower respiratory tracts.
Together, the two tracts are responsible
for ventilation (movement of air in and out
of the airways). The upper tract, known as
the upper airway, warms and filters
inspired air so that the lower respiratory
tract (the lungs) can accomplish gas
exchange. Gas exchange involves
delivering oxygen to the tissues through
the bloodstream and expelling waste
gases, such as carbon dioxide, during
expiration
Bronchioles and alveoli. Your
bronchioles are some of the
smallest airways in your lungs.
Inhaled air passes through
tiny ducts from the bronchioles
into elastic air sacs (alveoli).
The alveoli are surrounded by
the alveolar-capillary
membrane, which normally
prevents liquid in the
capillaries from entering the
air sacs.
WHAT IS THE APPROPRIATE
POSITION FOR PATIENTS WITH
Turning the patient with ARDS from a supine to a prone
position can increase pulmonary capillary perfusion and
oxygenation. The physiologic changes (fluid shifting from the
posterior lung, allowing undamaged alveoli to be filled with
oxygenated blood) that occur when turning a patient into a
prone position improve ventilation. Prone positioning also
promotes pulmonary toileting and alveoli opening, and it
has been associated with a decrease in ventilator-induced
acute lung injury.
ARDS occurs as a result of an inflammatory trigger that initiates the
release of cellular and chemical mediators, causing injury to the
alveolar capillary membrane. This results in leakage of fluid into the
alveolar interstitial spaces and alterations in the capillary bed. Severe
ventilation–perfusion mismatching occurs in ARDS. Alveoli collapse
because of the inflammatory infiltrate, blood, fluid, and surfactant
dysfunction. Small airways are narrowed because of interstitial fluid and
bronchial obstruction. The lung compliance becomes markedly decreased
(stiff lungs), and the result is a characteristic decrease in functional residual
capacity and severe hypoxemia. The blood returning to the lung for gas
exchange is pumped through the nonventilated, nonfunctioning areas of the
lung, causing a shunt to develop. This means that blood is interfacing with
nonfunctioning alveoli and gas exchange is markedly impaired, resulting in
severe, refractory hypoxemia.
 Aspiration (gastric secretions, drowning, hydrocarbons)
 Drug ingestion and overdose
 Hematologic disorders (disseminated intravascular coagulopathy [DIC],
massive transfusions, cardiopulmonary bypass)
 Prolonged inhalation of high concentrations of oxygen, smoke, or
corrosive substances
 Localized infection (bacterial, fungal, viral pneumonia)
 Metabolic disorders (pancreatitis, uremia)
 Shock (any cause)
 Trauma (pulmonary contusion, multiple fractures, head injury)
 Fat or air embolism
 Systemic sepsis
 Clinically, the acute phase of ARDS is marked by a rapid onset of
severe dyspnea that usually occurs 12 to 48 hours after the initiating
event.
 Labored and rapid breathing
 Severe shortness of breath
 Muscle fatigue and general weakness
 Low blood pressure
 Discolored skin or nails
 A dry, hacking cough
 Fever
 Headaches
 Tachycardia
 Confusion
 - 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.
- 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.
- CT scans can provide detailed information about the structures
within the heart and lungs.

- This painless test tracks the electrical activity in your

heart. It involves attaching several wired sensors to your body.
- A sonogram of the heart, this test can reveal problems
with the structures and the function of your heart.
Different classes of drugs (other than antibiotics) and fluids
prescribed for management of ARDS.
Drugs
Corticosteroids Methyl prednisolone
Hydrocortisone
Dexamethasone
No steroids
IV fluids Dextrose Normal Saline
Normal Saline
Ringer lactate
5% dextrose
No Fluids
Diuretics Furosemide
A-Methapred, Depo-Medrol, Solu-MEDROL

Classification
Therapeutic: anti-inflammatories (steroidal),
immunosuppressant
Pharmacologic: corticosteroid

Action
Suppresses inflammation and the normal immune
response.
Biocort, Corbal/Corbal-250, Cortizan, Cortizol

Classification
Corticosteroids, Glucocorticoids, Adrenal Cortical
Steroid

Action
Corticosteroid Hormone Receptor Agonist.
Generic Name: dexamethasone (oral) (dex a METH a sone)
Brand Names: Baycadron, Decadron, Dexamethasone Intensol,
DexPak, TaperDex, Zema-Pak, ZoDex, Zonacort

Dexamethasone is a corticosteroid that prevents the release of

substances in the body that cause inflammation.

Dexamethasone is used to treat many different inflammatory

conditions such as allergic disorders and skin conditions.

Dexamethasone is also used to treat ulcerative colitis,

arthritis, lupus, psoriasis, and breathing disorders.
Generic Name: furosemide (oral/injection) (fur OH se mide)
Brand Names: Lasix, Diaqua-2, Lo-Aqua

Furosemide is a loop diuretic (water pill) that prevents your

body from absorbing too much salt. This allows the salt to
instead be passed in your urine.
Furosemide is used to treat fluid retention (edema) in people
with congestive heart failure, liver disease, or a kidney
disorder such as nephrotic syndrome.
Furosemide is also used to treat high blood pressure
Nursing diagnosis
Anxiety
Decreased Cardiac Output
Fatigue
Fear
Impaired Gas Exchange
Ineffective airway clearance
Ineffective coping
Ineffective tissue perfusion
Risk for infection
Planning
The patient will express feelings of reduced
anxiety.
The patient will remain hemodynamically
stable.
The patient will verbalize the importance of
balancing activity with adequate rest periods.
The patient will discuss fears or concerns.
The patient will maintain adequate ventilation
and oxygenation.
The patient will maintain patent airway
The patient will use of support systems to assist
with coping.
The patient will maintain adequate
cardiopulmonary perfusion.
The patient will remain free from signs or
symptoms of infection.
Nursing Interventions
Obtain all necessary supplies and notify respiratory therapy and radiology in preparation for
intubation and mechanical ventilation.
Explain the purpose and procedure of intubation.
Provide an opportunity to express fears related to intubation and mechanical ventilation; answer
questions and provide reassurance.
Discuss communication strategies while intubated. ; obtain a magic slate.
Administer analgesics and/or sedatives as ordered.
Monitor oxygen saturation every 30 to 60 minutes initially after instituting mechanical ventilation;
report changes to the physician.
Obtain ABGs as ordered or indicated; monitor and report results.
Suction via endotracheal tube as needed to maintain clear airways.
Allow periods of uninterrupted rest.
Monitor vital signs every 1 to 2 hours.
Assess skin color, capillary refill, and the presence of edema every 4 hours.
Monitor urine output hourly; report output of less than 30 mL per hour.
Assess lung sounds and chest excursion every 1 to 2 hours.
The acute respiratory distress syndrome (ARDS) is a major
cause of acute respiratory failure. Its development leads to
high rates of mortality, as well as short- and long-term
complications, such as physical and cognitive impairment.
Therefore, early recognition of this syndrome and application
of demonstrated therapeutic interventions are essential to
change the natural course of this devastating entity.