Acute Respiratory Distress Syndrome (ARDS)
Published on February 27th, 2021. Information updated on March 24th, 2021.
Acute respiratory distress syndrome (ARDS) is a lung condition where the blood oxygen level is deficient. This severe condition is similar to COVID-19 because oxygen levels go down and shortness of breath occurs in severe symptoms. Individuals who have ARDS would also have another disease or a significant injury. Additionally, fluid builds up in the lungs’ air sacs, which breaks down a substance in the lungs called surfactant. Surfactant is a foamy substance, which enables us to breathe because the lungs are expanded. However, without surfactant, the lungs prevent air from filling itself correctly, making the lung tissue scar and stiff. Therefore, the oxygen can’t go to the bloodstream and throughout the body.
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Causes
Since this disease is an acute condition, the main cause is an injury of two types: direct and indirect lung injuries. However, this can also arise from an occurring illness like COVID-19. As a result, there is fluid from tiny blood vessels that leak through the alveoli, damaging the air sacs’ walls and limiting oxygen being distributed throughout the body. Here are injuries of those categories listed below. Keep in mind that these causes can vary from patient to patient.
Conditions leading to direct lung injury:
Pneumonia: this is the infection of the air sacs that inflames one or both lungs.
Breathing in toxic substances: These include but not limited to tobacco smoke, mutagens, carcinogens, and irritants.
Bruising of the lungs: Occurs from chest trauma
COVID-19: Infectious disease caused by SARS-CoV-2 which initiated a pandemic and people were more likely to get ARDS if they have COVID-19.
Fat embolism: When fat enters the bloodstream that affects the vessels in the lungs.
Conditions leading to indirect lung injury:
Sepsis: Blood poisoning that infects the bloodstream which significantly decreases blood pressure.
Pancreatitis: Inflammation of the pancreas
Drug overdose: Similar to breathing in toxic substances, intaking or inducing an excessive amount of drugs can lead to ARDS.
The majority of the patient get ARDS from either pneumonia or sepsis.
Risk Factors
There are a lot of risk factors for ARDS because they are associated with the causes. Here are the risk factors listed below.
Infections such as the flu, adenovirus, COVID-19, and other viruses can affect the lungs.
Pneumonia and sepsis affect the lungs as these conditions are the main cause of ARDS.
Older people
Newborns: Although newborns don’t usually have ARDS, they can have it when the mother has a uterine infection that affects the baby’s lungs.
Heredity: If either the mom or dad has genes that affect the lungs, the offspring will most likely have ARDS.
Air Pollution: If individuals are exposed to air pollution for a long time, they are more vulnerable to ARDS.
Treatment and Medical Procedures: Although medical procedures have been proven to be safe, according to the doctor, some can be risky for the patient, especially when the medical practice involves the lungs.
Ethnicity: Individuals who have color (or nonwhites) are more likely to have ARDS, and this could be associated with air pollution depending on where they live.
Gender: males are at a higher risk than females.
Signs and Symptoms
There are obvious signs and symptoms for ARDS, so it’s easily diagnosable. Signs and symptoms include:
Shortness of breath (SOB)
Fast breathing
Rapid heart rate
Coughing that produces phlegm
Blue fingernails or blue tone of skin
Fatigue
Fever
Crackling of the lungs when heard from a stethoscope
Chest pain
Low blood pressure (hypotension)
The confusion comes from hypotension
Although ARDS is easy to diagnose, other diseases are rising, such as COVID-19, which can confuse some of the signs and symptoms present.
Diagnosis
Fortunately, ARDS can be diagnosed and may be treated in an early stage. Diagnostic tests include:
Physical Exam: The doctor listens to the lungs by placing the stethoscope on the chest to identify any crackling sounds.
EKG Test: This test is done to rule out other diseases with similar symptoms to ARDS.
Blood tests: Usually performed to test the blood’s oxygen levels, and if it’s low, then it’s likely to be ARDS.
Chest x-ray: Performed to identify fluid in the lungs because it produces detailed images.
CT scan: Checks infections in the lungs.
Pulse oximetry: Used to identify the saturation level for the oxygen
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Treatment
There are a variety of treatments for ARDS, which can treat the cause for the individual. Here are the main ones listed below:
Breathing support is the main treatment for ARDS which includes oxygen therapy, non-invasive ventilation, and a ventilator.
Medications such as acid-reducing medicines, antibiotics, blood thinners, muscle relaxants, pain medicines, and sedatives can also help reduce the symptoms and/or the underlying cause.
Additional treatments like blood transfusion, Extracorporeal membrane oxygenation (ECMO), fluid management, nutritional support, physical therapy, and appropriate body positions can help with other diseases to cure ARDS.
If an individual is diagnosed with ARDS, then it’s essential to follow the treatment plan the physician recommended. The individual must have regular check-ups with the doctor to see if the symptoms are reduced and to possibly have a counseling appointment to support the patient. Lastly, which I think is the most important follow-up, is to change your lifestyle. Lifestyle changes include limiting alcohol consumption, avoid having illegal drugs and avoid smoking.
Complications
Despite the diagnosis and treatment given, ARDS is fatal, and to top it off, complications are also included, which are life-threatening. Complications are listed below:
Atelectasis: When air pockets in the lungs collapse and deteriorate.
Treatment in a hospital: Complications of treatment in the hospital can include blood clots that form because of lying down for a long time. Other treatment complications include muscle weakness, infections, stress ulcers, depression, and problems with cognitive thinking due to sedatives being induced in the body.
Failure of multiple organs: This is the most life-threatening and possibly fatal.
Pulmonary hypertension: The increase of blood pressure in the major artery from the heart to the lungs because the blood vessels become narrower as a lack of oxygen is in the body.
Prevention
If the risk factors apply to an individual, then doctors must perform a screening for ARDS. Preventing the increasing risk of developing ARDS is getting vaccines to prevent the flu and COVID-19, avoid smoking, limit alcohol and drugs, and limiting exposure to polluted air. On a side note, COVID-19 made over 2.5 million deaths worldwide, but some of those deaths could potentially come from developing ARDS because ARDS is often fatal. Thanks to the COVID-19 vaccine, the mortality rate has slightly decreased.
Check out these resources for more information.
Resources
Acute Respiratory Distress Syndrome (ARDS). (2020, October 29). Yale Medicine. https://www.yalemedicine.org/conditions/ards
Acute Respiratory Distress Syndrome | NHLBI, NIH. (2019, September 17). National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/acute-respiratory-distress-syndrome
ARDS - Symptoms and causes. (2020, June 13). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ards/symptoms-causes/syc-20355576
Toxic Substance | Encyclopedia.com. (2019). Encyclopedia.Com. https://www.encyclopedia.com/environment/encyclopedias-almanacs-transcripts-and-maps/toxic-substance#:%7E:text=Toxic%20substances%20are%20materials%20that,%2C%20liquid%2C%20or%20gaseous%20form.