Acute Respiratory Distress Syndrome (ARDS) — Know It All!

Editorial

All you need to know about Acute Respiratory Distress Syndrome (ARDS).

Know your ailment well, so you can manage it better!!

Here we come with Acute Respiratory Distress Syndrome today!

Acute Respiratory Distress Syndrome

What is ARDS?

ARDS is also referred to as “Wet Lung”.

Few patients with non-thoracic trauma, extreme pancreatitis, major transfusion, sepsis, and other illnesses have been known to experience respiratory depression, diffuse lung infiltrates, and respiratory collapse since World War I, often after hours or days of delay. In 1967, Ashbaugh et al identified 12 such patients to describe this disorder, using the word “adult respiratory distress syndrome”.

There was a need to formulate a specific description of the syndrome before studies into the pathogenesis and treatment of this syndrome could continue. The American-European Consensus Conference (AECC) on acute respiratory distress syndrome established such a concept in 1994 (ARDS). Instead of “adult respiratory distress syndrome,” the word “acute respiratory distress syndrome” was used because the syndrome exists in adults and children alike.

The most extreme cause of acute lung injury (ALI), a form of diffuse alveolar injury, has been known as ARDS. In the absence of evidence for cardiogenic pulmonary edoema, the AECC described ARDS as an acute condition marked by bilateral lung infiltrates and extreme hypoxemia. The ratio of the partial oxygen pressure in the arterial blood of the patient (PaO2) to the fraction of oxygen in the inspired air was defined as the magnitude of hypoxemia required for the diagnosis of ARDS (FiO2). The PaO2/FiO2 ratio was described as less than 200 for ARDS, and less than 300 for ALI.

A team of experts further refined this definition in 2011, and it is considered the Berlin definition of ARDS. Timing (within 1 week of therapeutic insult or onset of respiratory symptoms) is characterised by ARDS; radiographic adjustments (bilateral opacities not fully explained by effusion, consolidation or atelectasis); edoema cause (not fully explained by heart failure or fluid overload); and incidence depending on the 5 cm continuous positive airway pressure ratio of PaO2/FiO2 (CPAP). Mild (PaO2/FiO2 200–300), mild (PaO2/FiO2 100–200), and extreme (PaO2/FiO2 ≤ 100) are the three groups.

What are the causes of Acute Respiratory Distress Syndrome?

Fluid leakage from the tiniest blood vessels in the lungs into the narrow air sacs where blood is oxygenated is the mechanical source of ARDS. Normally, this substance is kept in the vessels by a protective membrane. However, severe illness or injury may cause membrane disruption, leading to the leaking of ARDS from the fluid.

What triggers Acute Respiratory Distress Syndrome?

ARDS triggers include:

Sepsis. Sepsis, a severe and widespread bloodstream infection, is the most frequent cause of ARDS.

Inhalation of chemicals that are toxic. Like inhaling (aspirating) vomit or near-drowning episodes, breathing high concentrations of smoke or chemical fumes can contribute to ARDS.

Severe Pneumonia. The five lobes of the lungs are normally compromised by serious cases of pneumonia.

Head, neck, or other serious injuries. Accidents, such as falls or car collisions, can affect the lungs or the part of the brain that regulates breathing directly.

The sickness of Coronavirus 2019 (COVID-19). ARDS can be formed by people who have extreme COVID-19.

Others. Pancreatitis (pancreatic inflammation), massive transfusions of blood, and burns.

Acute Respiratory Distress Syndrome
Acute Respiratory Distress Syndrome

What are the symptoms of Acute Respiratory Distress Syndrome?

You may not have any symptoms of acute kidney failure. Your doctor may discover you have this condition while doing lab tests for another reason.

If you do have symptoms, they’ll depend on how bad your loss of kidney function is, how quickly you lose kidney function and the reasons for your kidney failure. Symptoms may include:

  • Peeing less than normal
  • Swelling in your legs, ankles, and feet (caused by your body holding on to fluid)
  • Feeling drowsy or very tired
  • Shortness of breath
  • Itching
  • Joint pain, swelling
  • Loss of appetite
  • Confusion
  • Throwing up or feeling like you’re going to
  • Chest pain or pressure
  • Muscle twitching
  • Seizures or coma (in severe cases)
  • Stomach and back pain
  • Fever
  • Rash
  • Nosebleed

What are the risk factors of Acute Respiratory Distress Syndrome?

For another condition, most persons that experience ARDS are now hospitalised, and many are seriously ill. If you have a common infection in your bloodstream, you’re highly at risk (sepsis).

There is a greater chance of developing ARDS in individuals who have a history of persistent alcoholism. They’re more likely to suffer from ARDS as well.

What are the complications of Acute Respiratory Distress Syndrome?

You can experience other medical conditions whilst in the hospital if you have ARDS. The most widespread questions are:

Clots of blood. Lying on a ventilator while still in the hospital will increase the risk of forming blood clots, particularly in the deep veins in your legs. A part of it will break apart and migrate to one or both of your lungs (pulmonary embolism) if a clot occurs in your leg, where it prevents blood flow.

Lung Collapsed (pneumothorax). In most ARDS situations, to raise oxygen in the bloodstream and push fluid out of the lungs, a breathing system called a ventilator is used. The friction and air volume of the ventilator, however will drive gas into the very outside of a lung to go into a narrow hole and allow the lung to collapse.

With pathogens. This makes it much easier for germs to infect and further damage the lungs when the ventilator is attached directly to a drain threaded into your windpipe.

The Scarring (pulmonary fibrosis). Within a few weeks of the onset of ARDS, scarring and thickening of the tissue between the air sacs may occur. This stiffens your lungs, making it much harder for oxygen to flow to the bloodstream from the air sacs.

More individuals are surviving ARDS due to better therapies. Many survivors, though, end up with potentially extreme and often permanent effects:

Problems with respiration. Many individuals with ARDS recover most of their lung function within several months to two years, but for the rest of their lives, others may have breathing problems. Also individuals who perform better typically have shortness of breath and exhaustion and will require a few months of supplemental oxygen at home.

Depression. Most survivors of ARDS also report going through a treatable period of depression.

Memory problems and thinking clearly. Sedatives and low blood oxygen levels can lead to memory loss and post-ARDS cognitive issues. The effects may decrease over time in some cases, but the damage may be permanent in others.

Fatigue and muscular weakness. Being in the hospital and on a ventilator can cause weakening of your muscles. Following treatment, you may also feel very tired.

Acute Respiratory Distress Syndrome

How is ARDS diagnosed?

You can send them to the emergency room if you believe that someone you know has ARDS. ARDS is a medical emergency, and it will help them survive the disease with an early diagnosis.

There are many different ways a doctor can diagnose ARDS. There is no conclusive procedure to detect this disease. The doctor can read your blood pressure, do a physical examination, and prescribe either of the following tests:

  • A blood test, a blood test
  • X-ray of the chest
  • A CT scan of
  • Swabs for the throat and nose
  • Electrocardiography
  • An echocardiogram of a
  • An Airway Analysis

Signs with ARDS can be low blood pressure and low oxygen in the blood. To rule out a heart attack, a doctor can depend on an electrocardiogram and an echocardiogram. A diagnosis of ARDS is confirmed if a chest X-ray or CT scan then reveals fluid-filled air sacs in the lungs.

To rule out other lung conditions, a lung biopsy may also be performed. This is rarely achieved, though.

What is the treatment for Acute Respiratory Distress Syndrome or Wet Lung?

At this time, there is no remedy for ARDS. Treatment depends on the patient’s encouragement as the lungs recover. The aim of compassionate treatment is to bring enough oxygen into the blood to provide it to your body to avoid harm and remove the damage that caused the production of ARDS.

Ventilator support

The extra oxygen will be provided for all patients with ARDS. Usually, oxygen alone is not enough and excessive levels of oxygen will damage the lungs as well. A ventilator is a system that is used to open airspaces that are shut down to assist with breathing function. A mask over the chest or a tube threaded into the windpipe attaches the ventilator to the patient.

Positioning in Prone

Patients with ARDS are usually in bed on their backs. ARDS patients are often rolled over on their belly to allow more oxygen into the blood because oxygen and ventilator treatments are at elevated levels when blood oxygen is still low. This is called proning, and for a time, it will help raise oxygen levels in the blood. It is a difficult process because, for this treatment, certain people are too ill.

Sedation and medicines to prevent locomotion

The ARDS patient normally requires sedation to alleviate shortness of breath and avoid anxiety. In order to help the patient adapt to the ventilator, often added drugs called paralytics are needed upfront. These drugs have serious side effects and must be tracked constantly for their risks and benefits.

Acute Respiratory Distress Syndrome

Regulation of fluids

In order to help prevent fluid from piling up in the lungs, doctors may give ARDS patients a drug called a diuretic to improve urination in the hope of eliminating excess fluid from the body. Since too much fluid removal will lower blood pressure and lead to kidney complications, this must be performed cautiously.

Extracorporeal membrane oxygenation (ECMO)

ECMO is a very complex therapy that brings blood out of the bloodstream and pumps it into a membrane that provides oxygen, extracts carbon dioxide and then adds the blood to the body. With multiple possible risks, this is a high-risk treatment. For any ARDS patient, it is not appropriate.

To recover from ARDS

For long periods of time, ARDS patients may need ventilation. That’s an average of seven to 14 days. Beyond this time, doctors can prescribe that a tube be inserted by a surgeon directly into the windpipe via the neck (tracheostomy). The doctor normally thinks it can take more weeks to heal from ventilator help. When the patient is free from the need for a ventilator, this tube can quickly be replaced. It is important to remember that ARDS persists in most individuals. On a long-term basis, they will not need oxygen and will recover much of their lung function. Others will suffer with muscle weakness and to recover their strength may require re-hospitalization or pulmonary rehabilitation.

Prevention :

There’s no means of absolutely stopping ARDS. However, by doing the following, you will be able to lower your chance of ARDS:

  • For any wound, illness or disease, seek immediate medical assistance.
  • Avoid tobacco smoking, and keep rid of second-hand smoke.
  • Just giving up on beer. Chronic use of alcohol can increase your risk of mortality and prevent proper functioning of the lungs.
  • Get the flu and pneumonia vaccine every five years on an annual basis. This reduces the chances of pulmonary infections.

References:

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https://www.mayoclinic.org/diseases-conditions/ards/diagnosis-treatment/drc-20355581

https://www.lung.org/lung-health-diseases/lung-disease-lookup/ards/ards-treatment-and-recovery

https://www.healthline.com/health/acute-respiratory-distress-syndrome#prevention

https://www.webmd.com/lung/ards-acute-respiratory-distress-syndrome

https://emedicine.medscape.com/article/165139-clinical