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 dyspnoea, hypoxemia and diffuse pulmonary infiltrates.

1. ACUTE
RESPIRATORY
DISTRESS
SYNDROME
DR.ASHUTOSHKUMARSINGH

2. Respiratory System Anatomy

3. Respiratory System Anatomy
cont……

4. Contd…

5. 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
dyspnoea, hypoxemia and diffuse pulmonary infiltrates.

6. Etiology & Risk Factors
Direct Lung Injury
– Common causes
• Aspiration of gastric contents
• Viral/bacterial pneumonia
– Less Common causes
• Chest trauma
• Embolism like fat, air, amniotic fluid
• Inhalation of toxic substances
• Near-drowning
• O2 toxicity
• Radiation pneumonitis

7. Etiology & Risk Factors
contd…….
Indirect Lung Injury
– Common causes
• Sepsis
• Severe traumatic injury
– Less common causes
• Anaphylaxis
• Prolonged Cardiopulmonary bypass surgery
• Disseminated intravascular coagulation
• Narcotic drug overdose
• Non-pulmonary systemic diseases
• Shock
• Massive or multiple blood transfusion

8. Schematic Representation of ARDS Pathophysiology

9. Clinical Manifestation
Early signs/symptoms
• Restlessness
• Dyspnoea
• Low blood pressure
• Confusion
• Extreme tiredness
• Change in patient’s behaviour
• Mood swing
• Disorientation
• If pneumonia is causing ARDS then client may have
• Cough
• Fever

10. Clinical Manifestation
contd……
Late signs & symptoms
• Severe difficulty in breathing i.e. labored, rapid
breathing.
• Shortness of breath.
• Tachycardia
• Cyanosis (blue skin, lips and nails)
• Thick frothy sputum
•Abnormal breath sounds-crackles
• PaCo2 with respiratory alkalosis.
• PaO2

11. Diagnostic Evaluation
History of above symptoms
On physical examination
– Auscultation reveals abnormal breath sounds – like
crackles.
The first tests done are :
– ABG analysis
– Blood tests
– Chest x-ray
– Bronchoscopy
– Sputum cultures
Other tests are :
– Chest CT Scan
– Echocardiogram

12. Berlin Definition of ARDS

13. Management
• Persons with ARDS needs to be hospitalized and require
treatment in an intensive care unit.
• No specific therapy for ARDS exists.
• Supportive measures :
– Supplemental oxygen
– Mechanical respirator
– Positioning strategies
• Turn the patient from supine to prone.
• Fluid management

14. What is this?

15.  Vollman Prone
positioner

16. Benefits
•  Atelectasis
• Improves V/Q mismatch
• It reduces lung constriction.
• Enhances mobilization of secretions
• Increases ventilation in dependent areas

17. Complications
Common complications are -
– Nosocomial pneumonia:
– Barotrauma
– Renal failure
Other complications are -
– O2 toxicity
– stress ulcers
– Tracheal ulceration
– Blood clots leading to DVT & pulmonary embolism.