Acute respirations distress syndrome

1. Acute Respiratory Distress
Syndrome (ARDS)

2. ARDS
• Acute respiratory distress syndrome (ARDS) is characterised
by non-cardiac pulmonary oedema and progressive
refractory hypoxaemia
• It is widely recognised as a severe form of acute respiratory
failure.

3. ETIOLOGY
Etiologies can be pulmonary or Non pulmonary.
These include:
• Pneumonia, sepsis, aspiration
• Shock (any cause)
• Trauma
• Metabolic, hematologic(eg DIC) and immunologic disorders.
• Inhaled agents, smoke, high concentration of oxygen, corrosive substances.
• Major surgery
• Fat or air embolism

4. PATHOPHYSIOLOGY

5. Clinical Manifestations
• Dyspnoea, tachypnoea and anxiety are early manifestations
• Progressive respiratory distress develops, with increasing respiratory
rate, intercostal retractions and use of accessory muscles of
respiration
• Cyanosis develops that may not improve with oxygen administration.
• Breath sounds are initially clear, but crackles (rales) and rhonchi
develop later.
• As respiratory failure progresses, mental status changes such as
agitation, confusion and lethargy occur.

6. Diagnostic Evaluation
• The hallmark sign for ARDS is a shunt; hypoxemia remains despite
increasing oxygen therapy.
• ABG
• Chest X-ray exhibits bilateral infiltrates.
• Pulmonary artery catheter readings: pulmonary artery wedge
pressure >18 mm Hg.
• CT SCAN
• PFT

7. Management
• The underlying cause for ARDS must be determined so appropriate
treatment can be initiated.
• Ventilatory support with PEEP will be instituted. PEEP keeps the
alveoli open, thereby improving gas exchange. Therefore, a lower
oxygen concentration (Fio2) can be used to maintain satisfactory
oxygenation.
• Fluid management must be maintained. The patient may be
hypovolemic due to the movement of fluid into the interstitium of the
lung.
• inotropic medications

8. Management
• Corticosteroids are used infrequently due to the controversy
regarding benefits of usage.
• Treatment of any infections with appropriate antibiotics
• A Swan–Ganz line may be placed to monitor pulmonary artery
pressures and cardiac output.
• Adequate nutrition should be initiated early and maintained
• Enteral or parenteral feeding is necessary to maintain nutritional
status and prevent tissue catabolism.

9. Managemnt…
• Low-molecular-weight heparin may be ordered to prevent
thrombophlebitis and possible pulmonary embolus or disseminated
intravascular coagulation, a possible complication of ARDS

10. Complications
• Infections, such as pneumonia, sepsis.
• Respiratory complications, such as pulmonary emboli, barotrauma,
oxygen toxicity, subcutaneous emphysema, or pulmonary fibrosis.
• GI complications, such as stress ulcer, ileus.
• Cardiac complications, such as decreased cardiac output and
dysrhythmias.
• Renal failure, disseminated intravascular coagulation

11. NURSING MANAGEMENT

12. Nursing Diagnoses
• Impaired gas exchange related to effects of near drowning evidenced
by increased respiration rate and decreasing oxygen saturations.
• Anxiety related to hypoxaemia evidenced by decreasing oxygen
saturations.
• Risk of decreased cardiac output related to mechanical ventilation
evidenced by decreasing blood pressure and increasing heart rate.
• Risk of injury related to endotracheal intubation evidenced by
haemoptysis.

13. Planning
■■ Obtain all necessary supplies 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.

14. Expected outcomes
• Breathe effectively with the mechanical ventilator.
• Demonstrate improved oxygen saturation, ETCO2 and ABG values
• Express fears related to intubation and mechanical ventilation.
• Demonstrate reduced anxiety levels (relaxed facial expression, ability
to rest).
• Maintain adequate cardiac output and tissue perfusion.
• Tolerate endotracheal intubation and mechanical ventilation without
evidence of infection or barotrauma.

15. Nursing Interventions
• Monitor oxygen saturation and ETCO2 levels every 30 to 60 minutes
initially after mechanical ventilation is commenced; report changes to
the doctor.
• Obtain ABGs as ordered or indicated; monitor and report results.
• Suction via endotracheal tube as needed to maintain clear airways.
• Provide periods of uninterrupted rest.
• Monitor vital signs every 1 to 2 hours.
• Assess skin colour, capillary refill and the presence of oedema every 4
hours.

16. Nursing management…
• Monitor urine output hourly; report output of less than 30 mL per
hour.
• Assess lung sounds and chest excursion every 1 to 2 hours