Acute respiratory distress syndrome

Acute respiratory distress syndrome, otherwise known as ARDS, is a very serious illness that is often times fatal. Although this is the most common outcome, some do survive, some recover completely, while others experience lasting damage to their lungs (ARDS, 2018). This syndrome is caused by fluid leakage from the smallest blood cells in the lungs into the tiny air sacs where blood is oxygenated. It most often occurs after the protective membrane is damaged due to severe injury or illness, such as sepsis, inhalation of harmful substances, head or chest major injury, severe pneumonia, pancreatitis, burns, or massive blood transfusions (ARDS, 2018). Tests that may be used to diagnose this syndrome include: blood tests, chest x-ray or CT scans, sputum cultures, a bronchoscopy, blood and urine cultures, and arterial blood gasses (Acute respiratory distress syndrome: MedlinePlus Medical Encyclopedia, n.d.).
When acute respiratory distress syndrome has occurred, other life threatening complications are likely to follow. This list includes, but is not restricted to the following issues: blood clots, especially deep vein thrombosis, also known as DVTs, in lower extremities, pneumothorax, various infections, difficulty breathing, depression, problems remembering and thinking clearly, and fatigue (ARDS, 2018). There are even occasions where the lungs attempt to heal themselves, and in that process, create scar tissue, which decreases the elasticity and makes it more difficult to breathe (Acute Respiratory Distress Syndrome/Lung Failure, n.d.). Therefore, these patients may often require additional care to combat these further complications. These patients will be given medications to prevent and treat infections, relieve pain and discomfort, prevent DVTs, minimize gastric reflux, and possibly to sedate them (ARDS, 2018). Due to the severity of the illness, there have been many research studies performed to find ways to help these patients most effectively.
In 2013, a clinical review was performed by two scholarly men by the names of Jonathan Silversides and Niall Ferguson. In it, they discuss their findings on ARDS in an article titled Acute respiratory distress syndrome – clinical ventilator management and adjunct therapy. Silversides and Ferguson first discuss the history of ARDS, what it means, and how to diagnose it, emphasizing that, “Addressing the underlying condition in a timely fashion is essential…” in assisting the patient to have the best possible outcome (Silversides and Ferguson, 2013). However, this is difficult since the syndrome can be confused with several other disease processes which have similar findings.
The article then goes on to talk about the goals of mechanical ventilation for patients with ARDS, which are “…to minimize iatrogenic lung injury while providing acceptable oxygenation and carbon dioxide clearance,” (Silversides and Ferguson, 2013). Although, ventilator-induced lung injuries are a concern for these patients, efforts to minimize these injuries have been “…focused on the use of low tidal volume ventilation…positive end-expiratory pressure…and minimisation of …harmful oxygen concentrations,” (Silversides and Ferguson, 2013).
The contributors also discussed other treatment methods, including pharmacological therapies, such as pulmonary vasodilators, fluid balance, neuromuscular blockades, Corticosteroids, and also nonpharmacological therapies. Inhaled nitric oxide is one short-acting pulmonary vasodilator that “…improves perfusion to well-ventilated alveoli, reducing intrapulmonary shunt and improving oxygenation,” (Silversides and Ferguson, 2013). Inhaled prostacyclins are similar to nitric oxide, but have not been studied as much as the other. Neuromuscular blockers have multiple benefits to patients with this syndrome, such as to “…improve patient-ventilator synchrony, to facilitate lung-protective ventilation, and to improve chest wall compliance… while they also reduce oxygen consumption by respiratory muscles…” (Silversides and Ferguson). Prone positioning is one nonpharmacological therapy that has been seen to have a positive effect on these patients.
Another article was published by Baishideng Publishing Group Inc in 2013 that was collaborated on by multiple contributors, and was called the Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. Similar to the first article, this also mentioned the history of ARDS, diagnostic methods, and that prone positioning is beneficial to these patients. However, this article does go into more detail about prone positions. This positioning “…may result in a more uniform distribution of lung stress and strain, leading to improved ventilation-perfusion matching and regional improvement in lung and chest wall mechanics,” (Efficacy, 2016). Therefore, especially in the first week of ventilation, it is better for the patient with moderate to severe ARDS to be in this position (Efficacy, 2016).
This conclusion about the importance of prone positioning within the first week of ventilation is based on several studies that have been performed over the years. The earliest of these studies occurred in 1974. The consistent findings have shown that “… by turning the patient to the prone position due to thoracic-lung shape modifications the intrapleural pressure becomes less negative in non-dependent and less positive in dependent regions” (Efficacy, 2016). This means that by positioning the patients as such, we are attempting to limit the stress that has been put on their lungs, making gas exchange an easier process.
Acute respiratory distress syndrome is a serious and commonly fatal syndrome that affects individuals who have suffered a serious illness or injury. This syndrome has the potential for many life-threatening complications. The main goal for these patients is to prolong gas exchange as much as possible. Patients may be on medications that will relax their muscles, decrease inflammation, and dilate pulmonary vasculature. The patient may be put on a ventilator to decrease stress on the lungs as well. Placing the patient in a prone position is a well documented way to limit the stress on the lungs as well. Patients will need large amounts of care, and monitoring of oxygenations levels will also be critical. Following the established and tested interventions will give these patients the best possible outcome.