Acute Respiratory Distress Syndrome
( ARDS )
Topic Including
- Introduction Of ARDS
- Definition Of ARDS
- Types Of ARDS
- Causes Of ARDS
- Risk Factors Of ARDS
- Pathophysiology Of ARDS
- Signs And Symptoms Of ARDS
- Diagnosis Of ARDS
- Medical Treatment Of ARDS
- Nursing Management Of ARDS
- Nursing Diagnosis On ARDS According To NANDA
- Nursing Interventions
Introduction
Acute Respiratory Distress Syndrome (ARDS) is a critical condition characterized by sudden and severe respiratory failure due to extensive inflammation and fluid accumulation in the alveoli, leading to impaired gas exchange and severe hypoxemia.
Definition
ARDS is defined as a type of respiratory failure resulting from various direct or indirect insults to the lungs, leading to acute onset of hypoxemia, non cardiogenic pulmonary edema, and bilateral infiltrates on chest imaging, not fully explained by heart failure or fluid overload.
Types
1. Direct (Pulmonary) ARDS
Resulting from direct injury to the lungs, such as pneumonia, aspiration, or inhalation injury.
2. Indirect (Extrapulmonary) ARDS
Resulting from systemic inflammation or injury, such as sepsis, trauma, or pancreatitis.
Causes of ARDS
Direct Causes
1. Pneumonia :- Infection leads to inflammation and fluid accumulation in the alveoli, impairing gas exchange.
2. Aspiration of Gastric Contents :- Inhalation of stomach contents into the lungs causes chemical injury and inflammation.
3. Inhalation Injury :- Inhalation of toxic substances like smoke or chemicals damages the alveoli and airways.
4. Near-Drowning :- Aspiration of water into the lungs disrupts the alveolar-capillary membrane, causing edema.
5. Pulmonary Contusion :- Blunt chest trauma leads to bleeding and inflammation in the lung tissue.
Indirect Causes
1. Sepsis :- A systemic infection leads to widespread inflammation, affecting the lungs' capillaries and alveoli.
2. Severe Trauma :- Trauma can cause a systemic inflammatory response, leading to lung injury.
3. Pancreatitis :- Inflammation from the pancreas releases enzymes and cytokines that can affect the lungs.
4. Blood Transfusions (TRALI) :- Transfusion-related acute lung injury occurs due to immune reactions between transfused blood components and the recipient's immune system.
5. Drug Overdose :- Some drugs can cause lung damage directly or through secondary complications like aspiration or altered respiratory function.
Risk Factors
- Sepsis: The most common risk factor for ARDS.
- Multiple trauma: Especially with lung contusion or fractures.
- Severe pneumonia
- Aspiration: Of gastric contents or other foreign substances.
- Chronic alcohol abuse
- High-risk surgeries
Pathophysiology
1. Injury or Insult: Direct or indirect lung injury.
2. Inflammatory Response: Activation of the immune system, release of cytokines.
3. Endothelial and Epithelial Damage: Increased permeability of alveolar-capillary barrier.
4. Exudative Phase: Fluid, proteins, and inflammatory cells leak into the alveoli (pulmonary edema).
5. Impaired Gas Exchange: Hypoxemia and decreased lung compliance.
6. Proliferative Phase: Repair processes begin, proliferation of fibroblasts and myofibroblasts.
7. Fibrotic Phase: (in some cases) Extensive fibrosis, further lung stiffness, and decreased compliance.
Signs And Symptoms
1. Severe Shortness of Breath (Dyspnea)
- Due to fluid in the alveoli and reduced lung compliance, patients struggle to breathe and get enough oxygen.
2. Rapid, Labored Breathing (Tachypnea)
- Due to as the body tries to compensate for low oxygen levels, the respiratory rate increases.
3. Hypoxemia (Low Blood Oxygen Levels)
- Due to impaired gas exchange in the lungs leads to insufficient oxygen entering the bloodstream, detectable via ABGs and pulse oximetry.
4. Cyanosis (Bluish Skin Color)
- Due to low oxygen levels in the blood cause a bluish tint to the skin, lips, and nail beds.
5. Crackles or Rales Heard on Auscultation
- Due to fluid in the alveoli and interstitial spaces causes abnormal lung sounds during breathing.
6. Fatigue and Confusion
- Due to decreased oxygen supply to the brain and muscles leads to fatigue and altered mental status.
7. Chest Pain
- Due to inflammation and strain from labored breathing can cause chest discomfort.
Diagnosis
1. Clinical Criteria (Berlin Definition)
- Acute onset (within one week of a known clinical insult)
- Bilateral opacities on chest imaging
- Respiratory failure not fully explained by cardiac failure or fluid overload
- PaO2/FiO2 ratio < 300 mmHg (severity based on ratio)
2. Imaging
- Chest X-ray or CT scan showing bilateral infiltrates
3. Laboratory Tests
- Arterial blood gases (ABGs) to assess hypoxemia
- Blood tests to identify underlying causes (e.g., infection, sepsis)
Medical Treatment
- Mechanical Ventilation: Low tidal volume ventilation strategy to minimize lung injury.
- Oxygen Therapy : High levels of oxygen to maintain adequate oxygenation.
- Prone Positioning: Improves oxygenation by altering the distribution of ventilation.
- Sedation and Paralysis: To facilitate mechanical ventilation.
- Fluid Management: Conservative fluid strategy to avoid fluid overload.
- Medications : Antibiotics for infections, corticosteroids in certain cases to reduce inflammation, vasopressors for hemodynamic support.
Surgical Management
Surgical interventions are generally not a primary treatment for ARDS but may be necessary for underlying conditions (e.g., surgical drainage of infected areas, tracheostomy for prolonged ventilation).
Nursing Management
1. Assessment: Continuous monitoring of respiratory status, vital signs, and oxygenation levels.
2. Airway Management : Ensure airway patency and assist with endotracheal tube care.
3. Ventilation Support : Monitor ventilator settings, assess for complications, and provide care to prevent ventilator-associated pneumonia (VAP).
4. Positioning : Assist with prone positioning and regular repositioning to prevent pressure ulcers.
5. Fluid Management : Monitor fluid intake and output, maintain fluid balance.
6. Nutrition : Ensure adequate nutrition via enteral or parenteral feeding.
7. Skin Care : Prevent pressure ulcers by regular skin assessment and care.
8. Emotional Support : Provide psychological support to patients and families.
Nursing Diagnosis According to NANDA
1. Impaired Gas Exchange related to alveolar-capillary membrane changes as evidenced by hypoxemia and abnormal ABGs.
2. Ineffective Breathing Pattern related to decreased lung compliance and respiratory muscle fatigue as evidenced by tachypnea and dyspnea.
3. Risk for Infection related to invasive procedures and immunosuppression.
4. Anxiety related to difficulty in breathing and fear of suffocation.
5. Imbalanced Nutrition Less than Body Requirements related to increased metabolic demand and decreased intake.
Nursing Interventions
1. Monitor Respiratory Status : Regularly assess breath sounds, respiratory rate, depth, and effort. Monitor ABGs and oxygen saturation.
2. Administer Oxygen Therapy : Ensure appropriate oxygen delivery and monitor the patient's response.
3. Manage Mechanical Ventilation : Collaborate with the respiratory therapist to adjust ventilator settings and ensure proper ventilator function.
4. Positioning : Regularly reposition the patient to promote lung expansion and drainage. Use prone positioning if indicated.
5. Fluid Management : Monitor intake and output, administer fluids judiciously, and watch for signs of fluid overload.
6. Infection Prevention : Use sterile techniques for invasive procedures, provide meticulous oral care, and monitor for signs of infection.
7. Emotional Support : Provide reassurance, explain procedures, and involve family members in the care process. Manage anxiety with appropriate interventions.
8. Education : Educate the patient and family about ARDS, its treatment, and prognosis. Provide information on strategies to prevent complications.
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