The document presents information about a seminar on Acute Respiratory Distress Syndrome (ARDS). The seminar aims to provide in-depth knowledge of ARDS including defining it, describing the pathophysiology and management. ARDS is a life-threatening condition that prevents enough oxygen from entering the blood. It occurs when the lungs become severely inflamed and fluid builds up in the tiny air sacs of the lungs. The seminar will discuss etiology, risk factors, clinical manifestations, diagnostic evaluation, complications, and the nurse's role in management.

1. Presented By:
Ms. Gautami S. Tirpude
Medical Surgical Nursing

2.  At The End Of The Seminar Students Will Gain
In Depth Knowledge Regarding Acute
Respiratory Distress Syndrome.

3.  At The End Of The Seminar Students will be able to:
 Define ARDS.
 Understand Anatomy and Physiology of Respiratory system.
 Enlist etiology and risk factors of ARDS.
 Describe pathophysiology of ARDS.
 List down clinical manifestations of ARDS.
 Explain Diagnostic evaluation for ARDS.

4.  Describe Complications of ARDS.
 Explain the role of nurse in the management
of ARDS.
 Understand the recent research regarding
ARDS.

5.  Acute respiratory distress syndrome (ARDS) is
a life-threatening lung condition that
prevents enough oxygen from getting into the
blood.

6.  Acute respiratory distress syndrome was first
described in 1967 by Ashbaugh and
colleagues.

7.  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.

9.  Acute respiratory distress syndrome ("ARDS"),
previously known as respiratory distress
syndrome ("ARDS"),adult respiratory distress
syndrome, or shock lung, is a severe, life-threatening
medical condition characterized by widespread
inflammation in the lungs. Although it can be triggered
by a respiratory infection, such as pneumonia, it is
more often a result of sepsis or significant trauma.

10.  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.

17. • Direct Lung Injury
– Common causes
• Aspiration of gastric contents or other
substances.
• Viral/bacterial pneumonia

18. – Less Common causes
• Chest trauma
• Embolism: fat, air, amniotic fluid
• Inhalation of toxic substances

19. • Near-drowning
• O2 toxicity
• Radiation pneumonitis

20. Indirect Lung Injury
 Common causes
• Sepsis
Less common causes
• Acute pancreatitis
• Anaphylaxis
• Prolonged Cardiopulmonary bypass surgery
• Disseminated intravascular coagulation

21. • Multiple blood transfusions
• Narcotic drug overdose (e.g., heroin)
• Non-pulmonary systemic diseases
• Severe head injury
• Shock
• Massive blood transfusion.

23. Phase I: Acute injury:-
Occurs within first 24 hour of injury.
Mild hypoxemia, dyspnea, tachypnea.
with or without evidence of pneumonia or
pulmonary edema; clinically may see only
respiratory alkalosis.

24. Phase II: Latent period:
 May last from several hours to 2 days
 Gradual development of patchy lung
infiltrates
 Hypoxemia resistant to increases in
supplemental oxygen administration

25. Phase III: Exudative phase
 Occurs 2-10 days after injury.
 Onset of acute respiratory failure.
 Progressive dyspnea, tachypnea, hypoxemia,
decreasing lung compliance.
 Diffuse rales heard on examination.
 Chest x-ray film showing patchy infiltrates
that fuse to become diffuse alveolar
infiltrates.

26.  Hemodynamic instability; may have signs of other
organ involvement.
 Signs of systemic inflammatory response syndrome.
 At tissue level, edematous alveoli, edema
accumulating in interstitial spaces and alveolar
consolidation secondary to accumulation of cellular
debris and fibrin; hyaline membrane development ;
surfactant dysfunction impairing gas exchange; lungs
showing microthrombus formation and occlusion.

27. Phase IV: Fibro proliferative phase
 Occurs 10 days after lung injury.
 Onset of severe physiologic abnormalities.
 Intrapulmonary shunting leading to refractory
hypoxemia and metabolic and respiratory
acidosis.
 Development of multiorgan involvement.
 Fever, systemic inflammation, refractory hypoxia,
loss of responsiveness to PEEP.

28. • Early signs/symptoms
– Restlessness
– Low blood pressure
– Confusion
– Change in patient’s behavior
• Mood swing
• Disorientation
• Change in LOC
– If pneumonia is causing ARDS then client may have
• Cough
• Fever

29.  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
– Metabolic acidosis
– Abnormal breath sounds, like crackles
– Increased PaCo2 with respiratory alkalosis.
– Decreased PaO2

30. • History of previous symptoms
• On physical examination
– Auscultation reveals abnormal breath sounds
• The first tests done are :
– Arterial blood gas analysis
– Bood tests
– Chest x-ray
– Bronchoscopy
– Sputum cultures and analysis
• Other tests are :
– Chest CT Scan
– Echocardiogram

32. • Common complications are;
– Nosocomial pneumonia:
– Barotrauma
– Renal failure
• Other complications are :
– O2 toxicity,
– stress ulcers,
– Tracheal ulceration,
– Blood clots leading to deep vein thrombosis &
– pulmonary embolism.

33. Goals of management:-
 Respiratory support
 Maintenance of hemodynamic stability
 Treatment of the underlying cause when
possible
 Prevention of complications

34.  Oxygen
 THERAPEUTIC MEASURES
 Mechanical ventilation
 Corticosteroids
 Nitric oxide
 Maintain hemodynamic stability
 Treat the underlying conditions
 Monitor for complications
MEDICAL MANAGEMENT

35. Oxygen:-
 Supplemental oxygen is the first choice of
treatment in the management of impaired
oxygen exchange. Although patients with Acute
lung injury and ARDS may have some response in
arterial oxygenation to supplemental oxygen
administration, more oxygen is not necessarily
better.

36. THERAPEUTIC MEASURES:-
 The patient with ARDS is cared for in an intensive
care unit.
 Treatment begins with oxygen therapy that is
adjusted based on repeated ABG results.
 Intubation and mechanical ventilation are necessary
in most cases, with the use of positive end-expiratory
pressure(PEEP) to keep the airways open.
 Diuretics may be used to reduce pulmonary edema,
but care must be taken to prevent fluid depletion.

37. CONTD…
 IV fluids are administered if blood pressure or
urine output is low.
 A pulmonary artery catheter may be used to
monitor hemodynamic status.
 If infection or sepsis is the underlying cause,
antibiotics are administered.
 Total parenteral nutrition may be given to
maintain nutritional status while the patient is
acutely ill.

38.  Positioning the patient with the less involved
lung in the dependent position allows the
better lung to be well perfused with blood
and may increase Pao2.
 Prone positioning has also been shown to
increase oxygenation in patients with ARDS.

39. Mechanical ventilation:-
 The overall goal is to maintain acceptable gas
exchange and to minimize adverse effects in
its application.

41. Positive end-expiratory pressure
 It improves the oxygenation and allowes
ventilation with gas of lower inspired oxygen
concentration.
 PEEP will prevent from complete alveolar
collapse and improve oxygenation by
increasing functional residual capacity.

42.  PEEP are usually required to maintain
adequate blood oxygen levels.
 The goals of ventilator support is to use the
least amount of Fio2 and PEEP possible to
maintain oxygen saturation at or above 90%
while decreasing the potential of oxygen
toxicity.

43. Corticosteroids:-
 The initial regimen consists
of methylprednisolone 2 mg/kg daily. After
3–5 days a response must be apparent. In 1–2
weeks the dose can be tapered to
methylprednisolone 0.5–1.0 mg daily.

44. Nitric oxide
 Inhaled nitric oxide (NO) potentially acts as
selective pulmonary vasodilator. Rapid
binding to hemoglobin prevents systemic
effects. It should increase perfusion of better
ventilated areas.

45. Maintain hemodynamic stability:-
 Monitoring is used to observe the effect of fluids
and degree of pulmonary edema. The use of
pharmacologic agents in the treatment of ARDS
varies according to the clients underlying disease
process. Inotropic agents (eg. Dobutamine ) may
be indicated to improve cardiac output and to
increase systemic blood pressure. Fluids are
carefully monitored to prevent further systemic
fluid overload.

46. Treat the underlying conditions:-
 Antibiotics are administered if suspected or
confirmed infection is present

47. Monitor for complications:-
 In addition to lung fibrosis, other complications
may arise during supporting management of the
client with ARDS, such as cardiac dysrhythmias
caused by hypoxemia, oxygen toxicity, renal
failure, thrombocytopenia, gastrointestinal
bleeding secondary to stress ulcers, sepsis from
invasive lines and disseminated intravascular
coagulation.

49.  Closely monitor the patient; frequently assess
effectiveness of treatment (eg, oxygen
administration, nebulizer therapy, chest
physiotherapy, endotracheal intubation or
tracheostomy, mechanical ventilation, suctioning,
bronchoscopy).
 Consider other needs of the patient (eg,
positioning, anxiety, rest).

50.  Identify any problems with ventilation that
may cause an anxiety reaction: tube
blockage, other acute respiratory problems
(eg, pneumothorax, pain), a sudden decrease
in the oxygen level, the level of dyspnea; or
ventilator malfunction.

51.  Sedation may be required to decrease the
patient’s oxygen consumption, allow the
ventilator to provide full support of
ventilation, and decrease the patient’s
anxiety.

52.  If sedatives do not work, paralytic agents
(used for the shortest time possible) may be
administered (with adequate sedation and
pain management); reassure the patient that
paralysis is a result of the medication and is
temporary; describe the purpose and effects
of the paralytic agents to the patient’s family.

53.  Closely monitor patients on paralytic agents:
ensure that the patient is not disconnected
from ventilator and that all ventilator and
patient alarms are on at all times, provide eye
care, minimize complications related to
neuromuscular blockade, anticipate the
patient’s needs regarding pain and comfort.

55.  From this topic we have learned about Acute
respiratory distress syndrome, and this
knowledge can apply in the clinical setting for
the management of patient who is diagnosed
with ARDS.

56.  Joyce M. black , Medical surgical nursing, Volume 2,
7th edition, Elsevier publication 2007, New Delhi.
Page no. 1895
 Lewis, Heitkemper, Dirksen et.al. medical surgical
nursing, assessment and management of clinical
problems. 7th edition. Mosby Elsevier publications,
New Delhi. Page number; 1463-64
 Phipps’s,Medical surgical nursing,8th ed,New
delhi:Elsevier publicationPp627
 Ross and Wilson, anatomy and physiology,11th
edition,New Delhi:Elsevier publicationPp141-143.

57.  En.wikipedia.org
 www.google.com
 https://www.ncbi.nlm.nih.gov/pubmed/2936
7411