Acute Respiratory Distress Syndrome

What Is ARDS?

ARDS, or acute respiratory distress syndrome, is a lung condition that leads to low oxygen levels
in the blood. ARDS can be life threatening. This is because your body's organs, such as the
kidneys and brain, need oxygen-rich blood to work properly.

ARDS usually occurs in people who are very ill with another disease or who have major injuries.
Most people are already in the hospital when they develop ARDS.

Overview

When you breathe, air passes through your nose and mouth into your windpipe. The air then
travels to your lungs' air sacs. These sacs are called alveoli (al-VEE-uhl-eye).

Small blood vessels called capillaries run through the walls of the alveoli. Oxygen passes from
the alveoli into the capillaries and then into the bloodstream. Blood carries the oxygen to all parts
of the body, including the body's organs.

In ARDS, infections, injuries, or other conditions cause the lung's capillaries to leak more fluid
than normal into the alveoli. This prevents the lungs from filling with air and moving enough
oxygen into the bloodstream.

When this happens, the body's organs don't get the oxygen they need. Without oxygen, the
organs may not work properly or may stop working completely.

Most people who develop ARDS are in the hospital for another serious health problem. Rarely,
people who aren't hospitalized have health problems (such as severe pneumonia) that lead to
ARDS.

If you have trouble breathing, call your doctor right away. If you have severe shortness of breath,
go to the nearest emergency room (have someone drive you) or call 9–1–1.

Outlook

ARDS treatment has improved in recent years. As a result, more people are surviving ARDS. This
condition affects about 190,000 people in the United States each year. About 7 out of 10 people
who get prompt and proper treatment for ARDS survive it.

Some people who survive recover completely. Others may have lasting damage to their lungs
and other health problems.

Researchers are studying new treatments for ARDS.

Other Names for ARDS

• Acute lung injury

• Adult respiratory distress syndrome
• Increased-permeability pulmonary edema
• Noncardiac pulmonary edema

ARDS used to be called stiff lung, shock lung, and wet lung.

What Causes ARDS?

Many conditions or factors can directly or indirectly injure the lungs and lead to ARDS. Some
common ones are:

• Sepsis. This is a condition in which bacteria infect the bloodstream.

• Pneumonia. This is an infection in the lungs.
• Severe bleeding due to an injury to the body.
• An injury to the chest or head, like a severe blow.
• Breathing in harmful fumes or smoke.
• Inhaling vomited stomach contents from the mouth.

It's not clear why some very sick or seriously injured people develop ARDS and others don't.
Researchers are trying to find out why ARDS develops and how to prevent it.

Who Is At Risk for ARDS?

People at risk for ARDS have a condition or illness that can directly or indirectly injure their lungs.

Direct Lung Injury

Conditions that can directly injure the lungs include:

• Pneumonia. This is an infection in the lungs.

• Breathing in harmful fumes or smoke.
• Inhaling vomited stomach contents from the mouth.
• Severe acute respiratory syndrome (SARS). This is a type of pneumonia.
• Using a ventilator. This is a machine that helps people breathe, but, rarely, it can injure
the lungs.
• Nearly drowning.

Indirect Lung Injury

Conditions that can indirectly injure the lungs include:

• Sepsis. This is a condition in which bacteria infect the bloodstream.

• Severe bleeding due to an injury to the body or having many blood transfusions.
• An injury to the chest or head, like a severe blow.
• Pancreatitis (PAN-kre-a-TI-tis). This is a condition in which the pancreas becomes
irritated or infected. The pancreas is a gland that releases enzymes and hormones.
• Fat embolism (EM-bo-lizm). This is a condition in which fat blocks an artery. A physical
injury, like a broken bone, can lead to a fat embolism.
• Drug overdose.

What Are the Signs and Symptoms of ARDS?

The first signs and symptoms of ARDS are feeling like you can't get enough air into your lungs,
rapid breathing, and low oxygen levels in the blood.

Other signs and symptoms depend on the cause of the condition. They may occur before ARDS
develops. For example, if pneumonia is causing ARDS, you may have a cough and fever before
you feel short of breath.

Sometimes, people with ARDS develop signs and symptoms such as low blood pressure,
confusion, and extreme tiredness. This may mean that the body's organs, such as the kidneys
and heart, aren't getting enough oxygen-rich blood.

Most people who develop ARDS are in the hospital for another serious health problem. Rarely,
people who aren't hospitalized have health problems (such as severe pneumonia) that lead to
ARDS.

If you have trouble breathing, call your doctor right away. If you have severe shortness of breath,
go to the nearest emergency room (have someone drive you) or call 9–1–1.

How Is ARDS Diagnosed?

Your doctor will diagnose ARDS based on your medical history, a physical exam, and results from
tests.

Medical History

Your doctor will ask about conditions you may have or have recently had that can lead to ARDS.
For a list of these conditions, see "Who Is At Risk for ARDS?" Your doctor also will ask whether
you have heart problems, such as heart failure, which can cause fluid to build up in your lungs.

Physical Exam
ARDS may cause abnormal breathing sounds, such as crackling. Your doctor will listen to your
lungs with a stethoscope to hear these sounds.

He or she also will listen to your heart and look for signs of extra fluid in other parts of your body.
Extra fluid may mean you have heart or kidney problems.

Your doctor will look for a bluish color on your skin and lips. A bluish color means your blood has
a low level of oxygen. This is a possible sign of ARDS.

Diagnostic Tests

Diagnostic tests are used to find the cause of your symptoms. You may have ARDS, or you may
have another condition that causes similar symptoms.

Initial Tests

The first tests done are:

• An arterial blood gas test. This blood test shows the oxygen level in your blood. A low
level of oxygen in the blood may be a sign of ARDS.
• Chest x ray. This test is used to take a picture of your lungs. It can show whether you
have extra fluid in your lungs.
• Blood tests, such as a complete blood count, blood chemistries, and blood cultures.
These tests help find the cause of ARDS, such as an infection.
• Sputum cultures. This test looks at the spit you've coughed up from your lungs. It can
help find the cause of an infection.

Other Tests

Other tests used to diagnose ARDS include:

• Computed tomography (to-MOG-rah-fee), or CT, scan. This test uses a computer to take
detailed pictures of your lungs. It may show lung problems, such as fluid in the lungs,
signs of pneumonia, or a lung tumor.
• Heart tests that look for signs of heart failure. Heart failure is a condition in which the
heart can't pump blood the way it should. This condition can cause fluid to build up in
your lungs.

How Is ARDS Treated?

ARDS is treated with oxygen, fluids, and medicines. Treatments are done in a hospital's intensive
care unit.
The main goals of treating ARDS are to get oxygen to your lungs and organs (like the brain and
kidneys) and treat the underlying condition that's causing ARDS.

Oxygen

First, your doctor will try to give you extra oxygen through soft, plastic prongs that fit into your
nose, or through a mask that fits over your mouth (or mouth and nose).

If your oxygen level doesn't increase or it's still hard for you to breathe, your doctor will give you
oxygen through a breathing tube. The flexible tube will be inserted through your mouth or nose
and into your windpipe.

Before inserting the tube, your doctor will squirt or spray a liquid medicine into your throat (and
possibly your nose) to make it numb. This helps prevent coughing and gagging when the tube is
inserted. Your doctor also will give you medicine, through an intravenous (IV) line into your
bloodstream, to make you sleepy and relaxed.

The breathing tube will be connected to a machine that helps you breathe (a ventilator). The
ventilator will fill your lungs with oxygen-rich air.

Your doctor will adjust the ventilator often to help your lungs get the right amount of oxygen. This
also will help prevent any further injury to your lungs from the pressure of the ventilator.

The breathing tube and ventilator are used until you can breathe on your own. If you need a
ventilator for more than a few days, your doctor may do a tracheotomy (tra-ke-OT-o-me). This
involves making a small cut in your neck to create an opening to the windpipe. Your doctor will
place the breathing tube directly into the windpipe. The tube is then connected to the ventilator.

Fluids

Fluids may be given to improve the flow of blood through your body and to provide nutrition. Your
doctor will make sure you get the right amount of fluids.

Too much fluid can fill the lungs, making it harder to get the oxygen you need. Not enough fluid
can limit blood and oxygen flow to the body's organs. Fluids usually are given through an IV line
inserted in one of your blood vessels.

Medicines

Your doctor may give you medicines to prevent and treat infections and to relieve discomfort.

Complications From ARDS

If you have ARDS, you can develop other medical problems while in the hospital. The most
common are infections, pneumothorax (noo-mo-THOR-aks; collapsed lung), lung scarring, and
blood clots.

• Infections. Being in the hospital and lying down for a long time can make you prone to
infections, such as pneumonia. Being on a ventilator also can put you at higher risk for
infections. Infections can be treated with antibiotics.
• Pneumothorax. This is a condition in which air or gas collects in the space around the
lungs, which can cause one or both lungs to collapse. The pressure of the air from a
ventilator can cause this condition. Your doctor will put a tube into your chest to remove
the air and let your lung(s) expand again.
• Lung scarring. ARDS causes the lungs to become stiff (scarred) and makes it hard for
them to expand and fill with air. Being on a ventilator also can cause lung scarring. Often,
lung scarring heals before you leave the hospital.
• Blood clots. Lying down for long periods can cause blood clots to form in your body. A
blood clot that forms in a vein deep in your body is called a deep vein thrombosis. This
type of blood clot can break off, travel through the bloodstream to the lungs, and block
blood flow. This is called pulmonary embolism.

Living With ARDS

Some people fully recover from ARDS. Others continue to have health problems. After you go
home from the hospital, you may have one or more of the following problems:

• Shortness of breath. After treatment, lung function in most people who have ARDS
improves within 3 months and is back to normal within 6 months. For others, it may take
up to a year or more. Some people have breathing problems for the rest of their lives.
• Tiredness and muscle weakness. Being in the hospital and on a ventilator (a machine
that helps you breathe) can cause your muscles to feel weak. You also may feel very
tired following treatment.
• Depression. Many people who've had ARDS say that they were depressed for a while
after treatment.
• Problems with memory and thinking clearly. Certain medicines and a low oxygen level in
your blood can cause these problems.

These health problems may go away within a few weeks or they may last longer. Talk to your
doctor about how to deal with these problems. Also, see the suggestions below.

Getting Help

You can take steps to recover from ARDS and improve your quality of life.
 • Ask your family and friends for help with everyday activities.
• Go to pulmonary rehabilitation (rehab). A rehab program can show you how to return to
normal activities and stay active. Rehab may include exercise training, education, and
counseling. Your rehab team may include doctors, nurses, and other specialists. They will
work with you to create a program that meets your needs.
• Join a support group for ARDS. The ARDS Support Center, the American Lung
Association's Better Breathers Clubs, and the ARDS Foundation are examples of support
networks that can help you learn about and cope with your condition.
• Seek help from a mental health professional if you feel depressed.
• Don't smoke, and avoid secondhand smoke.

Key Points

• ARDS, or acute respiratory distress syndrome, is a lung condition that leads to low
oxygen levels in the blood. ARDS can be life threatening. This is because your body's
organs, such as the kidneys and brain, need oxygen-rich blood to work properly.
• Most people who develop ARDS are in the hospital for another serious health problem.
Rarely, people who aren't hospitalized have health problems (such as severe pneumonia)
that lead to ARDS. If you have trouble breathing, call your doctor right away. If you have
severe shortness of breath, go to the nearest emergency room (have someone drive you)
or call 9–1–1.
• In ARDS, infections, injuries, or other conditions cause the lung's tiny blood vessels to
leak more fluid than normal into the lungs' air sacs. This prevents the lungs from filling
with air and moving enough oxygen into the bloodstream.
• Some common conditions and factors that can lead to ARDS are sepsis, pneumonia,
severe bleeding due to an injury, an injury to the chest or head, breathing in harmful
fumes or smoke, and inhaling vomited stomach contents from the mouth.
• People at risk for ARDS have a condition or illness that can directly or indirectly injure
their lungs.
• The first signs and symptoms of ARDS are feeling like you can't get enough air into your
lungs, rapid breathing, and low oxygen levels in the blood. Other signs and symptoms
depend on the cause of the condition. They may occur before ARDS develops.
• Your doctor will diagnose ARDS based on your medical history, a physical exam, and
results from tests.
• ARDS is treated with oxygen, fluids, and medicines. Treatments are done in a hospital's
intensive care unit. Patients who have ARDS can develop other medical problems while
in the hospital. The most common problems are infections, pneumothorax (collapsed
lung), lung scarring, and blood clots.
 • Some people fully recover from ARDS. Others continue to have health problems. These
problems may include shortness of breath, tiredness and muscle weakness, depression,
and problems with memory and thinking clearly.
• You can take steps to recover from ARDS and improve your quality of life. Ask you family
and friends to help with everyday activities. Go to pulmonary rehabilitation if you doctor
recommends it. Join a support group for ARDS. Seek help from a mental health
professional if you feel depressed. Don't smoke, and avoid secondhand smoke.
• ARDS treatment has improved in recent years. As a result, more people are surviving
ARDS. Researchers are studying new treatments for the condition.

http://www.nhlbi.nih.gov/health/dci/Diseases/Ards/Ards_WhatIs.html

Adult (Acute) Respiratory Distress Syndrome (ARDS)

Acute respiratory distress syndrome (ARDS) is the rapid onset of respiratory failure
(ability to adequately oxygenate the blood) that can occur in critically ill persons of
any age over 1 year. The condition can be life threatening and occurs when the lungs
cannot perform normal gas exchange due to severe fluid buildup in both lungs.

• ARDS is mainly caused by extensive lung inflammation and small blood vessel
injury due to sepsis (generalized infection), trauma and/or severe pulmonary
infection such as pneumonia. However, ARDS can be associated with multiple
transfusions, inhalation of salt water, smoke inhalation, tricyclic
antidepressants overdoses and shock from any cause.
• Onset usually occurs within 24 hours to 3 days of the original illness or
injury. At 72 hours, 85 percent of patients have clinically apparent ARDS.
• The incidence of ARDS has been difficult to determine but various published
estimates have ranged from 1.5 to 75 cases per 100,000 populations. NHLBI
suggest that ARDS affects about 150,00 people each year in the United
States.
• ARDS has a fatality rate of approximately 30 to 40 percent. Deaths usually
result from multisystem organ failure rather than lung failure alone.
• The majority of ARDS patients who survive will make a full recovery, however,
some will have lasting damage to their lungs. A study found that survivors of
ARDS may have persistent functional disability one year after discharge from
the intensive care unit, most commonly muscle wasting and weakness.
• ARDS patients are usually treated in the intensive or critical care unit of a
hospital. Treatment consists of mechanical ventilation along with careful
attention to fluid balance and a supportive breathing technique called positive
end expiratory pressure (PEEP). These are combined with continuing
treatment of the precipitating illness or injury.
• A recent study found that receiving small, rather than large, breaths of air
from a mechanical ventilator reduced the number of deaths by 22 percent and
increased the number of days without ventilator use.
• There are many experimental therapies that show promise for the treatment
of ARDS. These include replacement surfactant (a natural soapy substance
that keeps the lung air sacs open) and the use of anti inflammatory agents.