Early Recognition and Management of Acute Respiratory Distress Syndrome (ARDS)

ARDS is a life-threatening lung condition with high mortality, requiring immediate critical care. It happens when the lungs swell, damaging the protective membrane on the alveoli. This causes fluid to enter the alveoli (the lungs’ air sacs), which prevents them from filling with air. The fluid-filled sacs make it hard for oxygen to enter the bloodstream. This results in an acute case of hypoxemia, when the body’s organs don’t receive what they need to function correctly.

Without early intervention, this condition can lead to Type 1 respiratory failure, organ failure, and, consequently, death. Nurses are often the first to spot telltale warning signs, and it’s essential for anybody working in the ICU to have a thorough understanding of the condition.

Understanding ARDS

ARDS typically presents in already critically ill patients whose lungs become inflamed through an infection like sepsis or pneumonia, major trauma, or COVID-19 complications. An ARDS diagnosis is serious. The mortality rate depends on the patient’s comorbidities and the severity of the disease, as described below.

Mild: 27%
Moderate: 32%
Severe: 45%

Nurses working in intensive care units (ICU) or training through online colleges for nursing will encounter ARDS cases. This may occur firstly as part of a simulation-based learning experience and later during physical hospital placements.

Early Signs

It’s imperative to identify symptoms as soon as possible for the best outcomes. Indications of ARDS include:

Sudden onset of tachypnea (rapid breathing)
Other respiratory symptoms like dyspnea (shortness of breath)
Use of accessory muscles like the scalene muscles or the sternocleidomastoid
Decreased SpO₂ despite O₂ therapy, or refractory hypoxia
Crackles on auscultation
Radiographic signs like bilateral infiltrates on CXR

Important note: Cardiac causes like heart failure should be ruled out when interpreting imaging and oxygenation results.

Evidence-Based Management Approaches

Treatment focusing on supporting the lungs should be given when ARDS is suspected or confirmed. Critically, lung-protective ventilation must be applied. Research from the Respiratory Distress Syndrome Network shows that using a low tidal volume (LTV), or 6 mL/kg of predicted body weight, can reduce mortality by 22%. This is in comparison to the traditional tidal volume (TV) of 12 mL/kg of predicted body weight. Use of a lower TV is also shown to reduce the number of days the patient requires ventilation.

Prone positioning improves oxygenation in moderate to severe ARDS, significantly reducing both 28 and 90-day mortality. Conservative fluid management should also be implemented. In some cases where oxygenation remains critically low, extracorporeal membrane oxygenation (ECMO) may be considered. Venovenous ECMO is still regarded as an alternative treatment option for severe cases of ARDS and requires medical devices that may only be found in specialist centres.

Endnote

ARDS is one of the most serious challenges in critical care. However, early recognition and evidence-based management can vastly improve mortality rates. Techniques such as LTVV, prone positioning, ECMO, and ICU protocols like conservative fluid strategies are recommended to improve outcomes. Nurses are key in identifying signs of deterioration and play a vital role in managing this life-threatening condition. Anybody training to work in intensive care must learn to recognize and respond to ARDS as a life-saving skill.