Acute respiratory distress syndrome is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs.

1. RESPIRATORY DISTRESS
SYNDROME
PRESENTED BY
MR.ABHAY RAJPOOT
M.SC.NURSING FINAL YEAR

2. DEFINITION
Infant respiratory distress syndrome (IRDS),is
a syndrome in premature infants caused by developmental
insufficiency of pulmonary surfactant production and structural
immaturity in the lungs.

3. INCIDENCE:
IRDS affects about 1% of newborn infants and is the leading cause of death
in preterm infants. The incidence decreases with advancing gestational age,
from about 50% in babies born at 26–28 weeks, to about 25% at 30–31
weeks. The syndrome is more frequent in males

4. Risk factor
 Prematurity
 Diabetes in the mother
 Caesarean delivery or induction of labor before the baby is full-
term
 Problems with delivery that reduce blood flow to the baby
 Multiple pregnancy (twins or more)

5. SURFACTANT:
Pulmonary surfactant is a surface-active lipoprotein complex
(phospholipoprotein) formed by type II alveolar cells. The proteins and
lipids that make up the surfactant have
both hydrophilic and hydrophobic regions. By adsorbing to the air-
water interface of alveoli, with hydrophilic head groups in the water and
the hydrophobic tails facing towards the air, the main lipid component of
surfactant, dipalmitoylphosphatidylcholine (DPPC), reduces surface
tension.

6. Functions:
 Decrease the surface tension
 To promote lung expansion during inspiration
 To prevent atelectasis (collapse of the lung) at the end of expiration.
 Surface tension forces also draw fluid from capillaries to the alveolar
spaces. Surfactant reduces fluid accumulation and keeps the airways
dry by reducing these forces.

8. CAUSES
 Neonatal RDS occurs in infants whose lungs have not yet fully
developed.
 The disease is mainly caused by a lack of a slippery substance in the
lungs called surfactant. This substance helps the lungs fill with air and
keeps the air sacs from deflating. Surfactant is present when the lungs
are fully developed.

9. PATHOPHYSIOLOGY:

10. SYMPTOMS:
 Bluish color of the skin and mucus membranes (cyanosis)
 Brief stop in breathing (apnea)
 Decreased urine output
 Nasal flaring
 Rapid breathing
 Shallow breathing
 Shortness of breath and grunting sounds while breathing
 Unusual breathing movement (such as drawing back of the
chest muscles with breathing)

11. DIAGNOSTIC EVALUATION
 Physical Examination
 History collection
 Blood gas analysis
 Chest x-ray

12. Chest X-ray.

13. COMPLICATIONS:
 Pneumothorax
 Pneumomediastinum
 Intraventricular hemorrhage of the newborn
 Bronchopulmonary dysplasia
 Retinopathy of prematurity

14. MANAGEMENT:
 Mechanical ventilation
 Thermoregulation
 Oxygen therapy
 Nutritional support
 Prevention from infection

15. PHARMACOLOGICAL MANAGEMENT
 Surfactant replacement therapy (exosurf , survanta)
 Antibiotic therapy (meropenum , piperacillin-tazobactum)
 Sedatives drugs (midazolam)
 Steroids (dexamethasone, hydrocortisone)
 Diuretics (furosemide)

16. NURSING MANAGEMENT
 Positioning
 Thermoregulation
 Fluid and electrolyte balance
 Intensive care monitoring
 Endotracheal suctioning
 Weaning from mechanical ventilation and intensive care
 Encourage parents participation in care

17. NURSING DIAGNOSIS
 Impaired gas exchange related to decreased lung compliance as evidenced
by cyanosis
 Ineffective breathing pattern related to decreased surfactant as evidenced by
shortness of breath
 Risk for infection related to invasive procedures
 Risk for aspiration related to presence of secretions

18. RESEARCH STUDY
Preterm infants with respiratory distress syndrome (RDS) face heightened
risks of death, critical illness, and prolonged hospitalization, particularly if
they progress to develop acute respiratory distress syndrome (ARDS). A
new study appearing in the journal CHEST®, published by Elsevier,
suggests that treatment with nasal high-frequency oscillatory ventilation
(NHFOV) is a beneficial management strategy in this population, and is
superior to nasal continuous positive airway pressure (NCPAP) in
preventing reintubation.

19. Summary

20. CONCLUSION
More recently, vitamin D has been shown to assist in lung maturation. The
correlation between lung maturation and vitamin D is explained by the
mechanism of phospholipid (surfactant) production and secretion on the
surface of alveolar type II (ATII) cells. The concentration of surfactant in
ATII cells is associated with pregnancy gestation; therefore, the maturation of
lung surfactant also progresses with pregnancy gestation.

21. Assignment
Nursing Care Plan

22. BIBLIOGRAPHY:
 Black M. joyce, Hwks hokanson jane,medical surgical nursing.8th edition.
volume 2. New delhi ;Reed elsevier india private limited:2009.p1438-
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 Siddharth’s and brunner, Hinkle L.Janice, Cheever H.Kerry. text book of
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kluwer india Pvt ltd ;2014.p701-720.
 https://www.hindawi.com/journals/aps/2018/8494816/
 https://www.nhs.uk/conditions/neonatal-respiratory-distress-syndrome/
 https://en.wikipedia.org/wiki/Infant_respiratory_distress_syndrome
 https://medlineplus.gov/ency/article/001563.htm
 https://www.stanfordchildrens.org/en/topic/default?id=respiratory-distress-
syndrome-90-P02371