Acute respiratory distress syndrome

 

Alternative Names

Noncardiogenic pulmonary edema; Increased-permeability pulmonary edema; ARDS; Acute lung injury

Definition

Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood. Infants can also have respiratory distress syndrome.

Causes

ARDS can be caused by any major direct or indirect injury to the lung. Common causes include:

  • Breathing vomit into the lungs (aspiration)
  • Inhaling chemicals
  • Lung transplant
  • Pneumonia
  • Septic shock (infection throughout the body)
  • Trauma

ARDS leads to a buildup of fluid in the air sacs (alveoli). This fluid prevents enough oxygen from passing into the bloodstream.

The fluid buildup also makes the lungs heavy and stiff, which decreases the lungs' ability to expand. The level of oxygen in the blood can stay dangerously low, even if the person receives oxygen from a breathing machine (ventilator) through a breathing tube (endotracheal tube).

ARDS often occurs along with the failure of other organ systems, such as the liver or kidneys. Cigarette smoking and heavy alcohol use may be risk factors.

Symptoms

Symptoms usually develop within 24 to 48 hours of the injury or illness. Often, people with ARDS are so sick they cannot complain of symptoms. Symptoms can include any of the following:

  • Difficulty breathing
  • Low blood pressure and organ failure
  • Rapid breathing
  • Shortness of breath

Exams and Tests

Listening to the chest with a stethoscope (auscultation) reveals abnormal breath sounds, such as crackles, which may be signs of fluid in the lungs. Often, blood pressure is low. Cyanosis (blue skin, lips, and nails caused by lack of oxygen to the tissues) is often seen.

Tests used to diagnose ARDS include:

An echocardiogram or Swan-Ganz catheterization may be needed to rule out congestive heart failure, which can look similar to ARDS on a chest x-ray.

Treatment

ARDS often needs to be treated in an intensive care unit (ICU).

The goal of treatment is to provide breathing support and treat the cause of ARDS. This may involve medicines to treat infections, reduce inflammation, and remove fluid from the lungs.

A ventilator is used to deliver high doses of oxygen and continued pressure (positive end-expiratory pressure, or PEEP) to the damaged lungs. Patients often need to be deeply sedated with medicines. During treatment, doctors and nurses make every effort to protect the lungs from further damage.

Support Groups

Many family members of people with ARDS are under extreme stress. Often they can relieve this stress by joining support groups where members share common experiences and problems.

Outlook (Prognosis)

About a third of people with ARDS die of the disease. Those who live usually get back most of their normal lung function, but many people have permanent (usually mild) lung damage.

Many people who survive ARDS have memory loss or other quality-of-life problems after they recover. This is due to brain damage that occurred when the lungs were not working properly and the brain was not getting enough oxygen.

Possible Complications

When to Contact a Medical Professional

Usually, ARDS occurs during another illness, for which the patient is already in the hospital. In some cases, a healthy person has severe pneumonia that gets worse and becomes ARDS. If you have trouble breathing, call your local emergency number (such as 911) or go to the emergency room.

References

Herridge MS. Recovery and long-term outcome in acute respiratory distress syndrome. Crit Care Clin. 2011;27:685–704.

Lee WL, Slutsky AS. Acute respiratory distress syndrome. In: Mason RJ, Murray JF, Broaddus VC, et al., eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Elsevier Saunders; 2010:chap 90.

Review Date: 2/8/2014
Reviewed By: Denis Hadjiliadis, MD, Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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