ACUTE RESPIRATORY DISTRESS SYNDROME

 

Introduction: Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury characterized by sudden and progressive pulmonary edema, increasing bilateral infiltrates, hypoxemia unresponsive to oxygen supplementation, and the absence of an elevated left atrial pressure. ARDS occurs when inflammatory triggers initiate the release of cellular and chemical mediators, causing injury to the alveolar capillary membrane in addition to other structural damage to the lungs. Inflammatory mediators  Factors associated with the development of ARDS include direct injury to the lungs such as during smoke inhalation, or indirect insult to the lungs such as in the case of shock. Shock  ARDS has been associated with a mortality rate ranging from 25% to 58%, with the major cause of death in ARDS being non-pulmonary multiple-system organ failure, often with sepsis.

Clinical Manifestations: Rapid onset of severe dyspnea, usually 12 to 48 hours after an initiating event. Intercostal retractions and crackles may be present. Arterial hypoxemia not responsive to oxygen supplementation. Lung injury then progresses to fibrosing alveolitis with persistent, severe hypoxemia. Increased alveolar dead space and decreased pulmonary compliance.

Assessment and Diagnostic Findings: Plasma brain natriuretic peptide (BNP) levels. Echocardiography. Pulmonary artery catheterization.

Medical Management: Identify and treat the underlying condition; provide aggressive, supportive care (intubation and mechanical ventilation; circulatory support, adequate fluid volume, and nutritional support). Use supplemental oxygen as the patient begins the initial spiral of hypoxemia. Monitor ABG values, pulse oximetry, and pulmonary function testing. As disease progresses, use positive end-expiratory pressure (PEEP). Treat hypovolemia carefully; avoid overload (inotropic or vasopressor agents may be required). There is no specific pharmacologic treatment for ARDS except supportive care.

RELATED;

1.  PNEUMONIA

2.  TUBERCULOSIS  

3.  PULMONARY EMBOLISM

4.  MEDICAL CONDITIONS

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