Acute Respiratory Distress Syndrome(ARDS)

1. Acute Respiratory Distress Syndrome(ARDS) Created by Nicole Shafar RN, BSN

2. ARDS • A type of pulmonary edema not related to heart failure. • It is also known as shock lung, or noncardiogenic pulmonary edema. • ARDS may follow direct or indirect lung injury (acute lung injury)and can quickly lead to acute respiratory failure.

3. What Causes an ALL? • shock • trauma • serious nervous system injury • pancreatitis • fat and amniotic fluid emboli • pulmonary infections • sepsis • inhalation of toxic gases (smoke, oxygen) • pulmonary aspiration • drug ingestion (heroin, opioids) • hemolytic disorders • multiple blood transfusions • cardiopulmonary bypass • near drowning (especially in fresh water)

4. Acute Respiratory Failure • Is present when you have these indicators • Hypoxemia that persists even when 100% oxygen is given. • decreased pulmonary compliance • dyspnea • noncardiac-associated bilateral pulmonary edema • dense pulmonary infiltrates on x-ray (will look like ground glass)

5. Why Does it Happen? • Main trigger is a systemic inflammatory response. • Major site of injury is the alveolar-capillary membrane, which is normally permeable to only small molecules. • This site can be injured from sepsis, pulmonary embolism, shock, aspiration, or inhalation injury.

6. Lung tissue normally remains dry but in patients with ARDS, lung fluid increases and contains a high level of protein. • It is estimated that 150,000-200,000cases occur annually.

7. Health Promotion and Maintenance • The nursing priority in the prevention of ARDS is early recognition of patients at high risk for the syndrome. • Patients who aspirate gastric contents are at great risk so closely monitor those receiving tube feeding and • those with problems that impair swallowing and gag reflexes.

8. Infection control is a PRIORITY!!

9. Signs and Symptoms • hyperpnea • Grunting respiration • Cyanosis • Pallor • Retraction intercostally or substernally • Sweating, respiratory effort, and any change in mental status should be documented.

10. How is it Diagnosed? • diagnosis is made by a lowered partial pressure of oxygen (PaO2) • sputum cultures are usually done to determine if an infection is also present. • chest x-ray usually shows diffuse haziness or a ground glass appearance • an EKG rules out cardiac problems • pulmonary capillary wedge pressure (PCWP) is usually low

11. Treatment • Corticosteroids • Antibiotics • Fluid therapy

12. Is Diet Important? • patient is at risk for malnutrition • therefore parenteral nutrition (PN) or enteral nutrition (EN) should be started as soon as possible.

13. How Do We Care For These Patients? • Care should focus on the different phases of ARDS rather than on day-to-day care. • The course of ARDS and its management is divided into four stages.

14. Stage One and Two • STAGE ONE: early changes of dyspnea and tachypnea, interventions focus on supporting the patient and providing oxygen. • STAGE TWO: patchy infiltrates form, increasing pulmonary edema, interventions are mechanical ventilation and prevention of complications.

15. Stage Three and Four • STAGE THREE: occurs days 2-10, progressive hypoxemia that doesn't respond well to oxygen, interventions focus on maintaining oxygen transport, preventing complications, and supporting the failing lung until it has time to heal. • STAGE FOUR: pulmonary fibrosis with progression occurs after 10days. This phase is irreversible and often called "late" or "chronic" ARDS. Patients who survive this will have some permanent lung damage. Interventions focus on preventing sepsis, pneumonia, and multiple organ dysfunction syndrome, weaning from ventilator. some patients are unable to be weaned an go home or to long term care on a mechanical ventilator.