ACUTE RESPIRATORY DISTRESS SYNDROME

1. ACUTE RESPIRATORY
DISTRESS SYNDROME
(ARDS)
1
PRESENTED BY
Mrs. SOUMYA SUBRAMANI, M.Sc.(N)
LECTURER, MSN DEPARTMENT
CON- SRIPMS, COIMBATORE.
Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

2. ACUTE RESPIRATORY DISTRESS
SYNDROME (ARDS)
• Acute respiratory distress syndrome was first described in 1967 by
Ashbaugh and colleagues.
• ARDS is also referred with variety of terms like
• Stiff Lung
• Shock lung
• Wet lung
• Post traumatic lung
• Adult respiratory distress syndrome
• Adult hyaline membrane disease
• Capillary leak syndrome &
• Congestive atelectasis.
2Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

3. DEFINITION
• Acute respiratory distress syndrome (ARDS) is a
sudden and progressive form of acute
respiratory failure in which the alveolar
capillary membrane becomes damaged and
more permeable to intravascular fluid resulting
in severe dyspnea, hypoxemia and diffuse
pulmonary infiltrates.
3Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

4. ETIOLOGY & RISK FACTORS
• Direct Lung Injury
– Common causes
• Aspiration of gastric contents or other substances.
• Viral/bacterial pneumonia
– Less Common causes
• Chest trauma
• Embolism: fat, air, amniotic fluid
• Inhalation of toxic substances
• Near-drowning
• O2 toxicity
• Radiation pneumonitis
4Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

5. ETIOLOGY & RISK FACTORS contd…….
• Indirect Lung Injury
– Common causes
• Sepsis
• Severe traumatic injury
– Less common causes
• Acute pancreatitis
• Anaphylaxis
• Prolonged Cardiopulmonary bypass surgery
• Disseminated intravascular coagulation
• Multiple blood transfusions
• Narcotic drug overdose (e.g., heroin)
• Nonpulmonary systemic diseases
• Severe head injury
• Shock
• Massive blood transfusion.
5Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

6. PATHOPHYSIOLOGY -Phases
1. Injury phase
2. Reparative phase
3. Fibrotic phase
6Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

7. 7Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

8. SCHEMATIC REPRESENTATION OF PATHOPHYSIOLOGY OF ARDS
Lung injury
Release of Vasoactive substances
(serotonin, histamine, bradykinin)
Damaged Type II alveolar cell
Surfactant production
Alveolocapillary
membrane
permeability
Vascular
narrowing&
obstruction
Alveolar
Compliance and recoil
Bronchoconstriction
Outward migration of
blood cells & fluids
from capillaries
Atelectasis
Pulmonary Edema
Hyaline membrane
formation
Lung
compliance
Impairment in
gas exchange
ARDS
Pulmonary
hypertension
8Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

9. CLINICAL MANIFESTATIONS
• Early signs/symptoms
– Restlessness
– Dyspnea
– Low blood pressure
– Confusion
– Extreme tiredness
– Change in patient’s behavior
• Mood swing
• Disorientation
• Change in LOC
– If pneumonia is causing ARDS then client may have
• Cough
• Fever
9Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

10. CLINICAL MANIFESTATIONS CONTD…………
Late signs & symptoms
– Severe difficulty in breathing i.e., labored, rapid
breathing.
– Shortness of breath.
– Tachycardia
– Cyanosis (blue skin, lips and nails)
– Metabolic acidosis
– Abnormal breath sounds, like crackles
– Hypoxemia, Hypercapnia
– Pleural effusion
10Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

11. – Echocardiogram
DIAGNOSITC EVALUATION
• History of above symptoms
• On physical examination
– Auscultation reveals abnormal breath sounds
• The first tests done are :
– Arterial blood gas analysis
– Bood tests
– Chest x-ray
– Bronchoscopy
– Pulmonary function test
– Sputum cultures and analysis
• Other tests are :
– Chest CT Scan
11Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

12. 12Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

13. MEDICAL MANAGEMENT
• Persons with ARDS are hospitalized and require
treatment in an intensive care unit.
• No specific therapy for ARDS exists.
• Supportive measures :
– Supplemental oxygen
– Mechanical ventilation
– Positioning strategies
• Turn the patient from supine to prone.
• Another position is lateral rotation therapy
• Fluid therapy
13Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

14. TURNING PATIENT PRONE ON VOLLMAN PRONE POSITIONER
14Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

15. PATIENT LYING PRONE ON VOLLMAN PRONE POSITIONER
15Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

16. 16Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

17. 17Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

18. LATERAL ROTATION THERAPY BED
18Mrs. SOUMYA SUBRAMANI, M.Sc.(N)

19. MEDICAL MANAGEMENT contd…….
• Medications :
– Antibiotics
– Anti-inflammatory drugs
– Diuretics
– Inotrops
– Neuromuscular blockers
– Bronchodilators
19Mrs. SOUMYA SUBRAMANI, M.Sc.(N)