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Acute Respiratory Distress Syndrome (ARDS) – Causes & Treatment

Acute Respiratory Distress Syndrome (ARDS) is a life-threatening lung condition in which severe inflammation causes the lungs to fail, preventing adequate oxygen from reaching the bloodstream.

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Things worth knowing about "Acute Respiratory Distress Syndrome"

Acute Respiratory Distress Syndrome (ARDS) is a life-threatening lung condition in which severe inflammation causes the lungs to fail, preventing adequate oxygen from reaching the bloodstream.

What is Acute Respiratory Distress Syndrome (ARDS)?

Acute Respiratory Distress Syndrome, commonly known as ARDS, is a severe and potentially life-threatening lung condition. It is characterized by rapid, widespread inflammation of the lung tissue that severely impairs the ability of the lungs to transfer oxygen into the blood. ARDS typically develops as a complication of another serious illness or injury and almost always requires treatment in an intensive care unit (ICU).

Causes

ARDS can be triggered by a wide range of conditions that damage the lungs either directly or indirectly:

Direct causes: Pneumonia, aspiration of stomach contents, lung contusion from trauma, inhalation of toxic substances
Indirect causes: Sepsis (a life-threatening response to infection), severe pancreatitis, major trauma (polytrauma), large-volume blood transfusions
Other triggers: COVID-19 infection, severe burns, shock states

Symptoms

Symptoms of ARDS typically develop within hours to a few days following the triggering event:

Severe shortness of breath (dyspnea) that worsens rapidly
Rapid, shallow breathing (tachypnea)
Low blood oxygen levels (hypoxemia) that do not improve adequately with supplemental oxygen
Bluish discoloration of the lips and fingernails (cyanosis)
Confusion or reduced consciousness due to insufficient oxygen reaching the brain
Crackling or rattling sounds when breathing

Diagnosis

ARDS is diagnosed using the internationally recognized Berlin Criteria (2012), which define three key diagnostic requirements:

Acute onset of symptoms within one week of a known triggering event
Bilateral opacities visible on chest X-ray or CT scan, not fully explained by other causes such as fluid overload or collapse
Impaired gas exchange, measured by the ratio of arterial oxygen pressure to the fraction of inspired oxygen (PaO2/FiO2 ratio)
Respiratory failure not fully explained by heart failure or fluid overload alone

Based on the PaO2/FiO2 ratio, ARDS is classified as mild, moderate, or severe.

Treatment

There is currently no specific drug that cures ARDS. Treatment focuses on stabilizing the patient and giving the lungs time to recover while managing the underlying cause.

Mechanical Ventilation

The cornerstone of ARDS treatment is mechanical ventilation via an endotracheal tube. A lung-protective ventilation strategy is used, employing low tidal volumes and adequate positive end-expiratory pressure (PEEP) to prevent further lung injury caused by the ventilator itself (ventilator-induced lung injury).

Prone Positioning

Prone positioning -- placing the patient face down for extended periods each day -- has been shown in clinical studies to significantly improve oxygenation and reduce mortality in patients with severe ARDS.

Supportive Medical Therapy

Treatment of the underlying cause (e.g., antibiotics for sepsis)
Corticosteroids may be used in selected cases to reduce the inflammatory response
Conservative fluid management to reduce further fluid accumulation in the lungs

ECMO

In the most severe cases of ARDS that do not respond to mechanical ventilation, extracorporeal membrane oxygenation (ECMO) may be used. This technique uses an external machine to oxygenate the blood and remove carbon dioxide, temporarily taking over the function of the lungs.

Prognosis

ARDS carries a high mortality rate of approximately 30 to 45 percent, depending on severity and underlying conditions. Survivors may experience long-term consequences including reduced lung capacity, muscle weakness, cognitive impairment, and post-traumatic stress disorder (PTSD).

References

ARDS Definition Task Force, Ranieri VM et al. - Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA. 2012;307(23):2526-2533.
Matthay MA, Zemans RL et al. - Acute respiratory distress syndrome. Nature Reviews Disease Primers. 2019;5(1):18.
World Health Organization (WHO) - Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. WHO Guidelines, 2020.

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