Acute respiratory distress syndrome

Noncardiogenic pulmonary edema; Increased-permeability pulmonary edema; Stiff lung; Shock lung; ARDS; Acute lung injury Last reviewed: March 3, 2012.

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

See also: Infant respiratory distress syndrome

Causes, incidence, and risk factors

ARDS can be caused by any major injury to the lung. Some 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. This fluid prevents enough oxygen from passing into the bloodstream.

The fluid buildup also makes the lungs heavy and stiff, and 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 (mechanical 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

Difficulty breathing

Low blood pressure and organ failure

Rapid breathing

Shortness of breath

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.

Signs 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 the 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:

Arterial blood gas

Blood tests, including CBC and blood chemistries

Bronchoscopy

Chest x-ray

Sputum cultures and analysis

Tests for possible infections

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

Typically people with ARDS need to be in an intensive care unit (ICU).

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

A breathing machine is used to deliver high doses of oxygen and continued pressure called PEEP (positive end-expiratory pressure) to the damaged lungs. Patients often need to be deeply sedated with medications when using this equipment. Some research suggests that giving medications to temporarily paralyze a person with ARDS will increase the chance of recovery.

Treatment continues until you are well enough to breathe on your own.

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.

See also: Lung disease - support group

Expectations (prognosis)

About a third of people with ARDS die from 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 weren't working properly and the brain wasn't getting enough oxygen.

Complications

Failure of many organ systems

Lung damage (such as a collapsed lung--also called pneumothorax) due to injury from the breathing machine needed to treat the disease

Pulmonary fibrosis (scarring of the lung)

Ventilator-associated pneumonia