Acute Respiratory Distress Syndrome (ARDS) is characterized by non-cardiac pulmonary edema and refractory hypoxemia. It is a severe form of acute respiratory failure caused by pneumonia, sepsis, trauma, shock, or inhalation of toxic substances. Clinically, it presents as progressive respiratory distress, cyanosis, and mental status changes. Diagnostically, chest imaging shows bilateral infiltrates while blood gases reveal hypoxemia despite oxygen therapy. Management focuses on treating the underlying cause, providing ventilatory support with PEEP, and maintaining fluid balance and nutrition. Nursing care monitors the patient's respiratory status and manages symptoms of ARDS.

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