Acute Respiratory Distress Syndrome (ARDS)

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Original Editors - Students from Glasgow Caledonian University's Cardiorespiratory Therapeutics Project.

Top Contributors - Geoff Boudreau, Matt Ross, Lucinda hampton, Kim Jackson, Adam Vallely Farrell, Chrysolite Jyothi Kommu, Hugh Collins, Mohit Chand, Vidya Acharya, Admin and Michelle Lee  

Definition/Description

Adult respiratory distress syndrome, more commonly referred to as acute respiratory distress syndrome (ARDS), is a life-threatening condition which is characterized by the sudden onset of severe dysnoea and hypoxemia. ARDS is typically a secondary condition and is induced by the inflammation of the alveolar-capillary interface, which results in protein and fluid entering the interstitial space and alveoli. This pulmonary infiltrate and can lead to respiratory failure or, in approximately 20-30% of ARDS cases, death. 

Although the lungs are the primary site of dysfunction for an individual with ARDS, many of the other systems will be compromised due to the decrease in blood oxygen levels. Because ARDS can occur in an individual of any age, the systemic impact of the condition may also result in serious complications later in life for the individual.

Epidemiology 

The prevalence of people suffering from ARDS differs greatly between geographical areas. Although the reason for the differences are unclear, some have speculated that it may stem from the differences in healthcare systems. The ability to diagnose and to differentiate the secondary condition is required to properly record and treat the patient. Future studies must be conducted in order to improve the ability to accurately diagnose the ARDS. 

In Scotland, the incidence of ARDS is estimated at 16 cases/100,000 people per year. Because the onset of ARDS is brought on by another condition or traumatic event, the majority of the condition is seen within intensive care-unit (ICU) patients. During an 8-month long study, researchers have found that 8.1% of ICU patients were suffering from ARDS. 

Aetiology

The causes of the disease or condition, current thinking and research activity as appropriate

Investigations

This may well include any investigations used to gain a diagnosis or that you might need to gain information about your patient assessment.

Clinical Manifestations

Clinical manifestations (the signs and symptoms your patient may well present to you on an examination) ensure you relate this back to the underlying pathophysiology.

Physiotherapy 

When treating a patient with ARDS, it is important to keep in mind that there will be both a physiological and psychological compenent to take into account. Because people suffering from ARDS will experience a difficult time to catch their beath, they will become highly anxious and stressed, which could exacerbate the condition. This is where physiotherapists play a key role in limiting the individual's psychological distress by educating the patient in regards to what they are going through as well as trying to keep the patient as calm as possible. With regards to the physiological management of the condition, there are several interventions that can be used to limit the negative effects of ARDS, which can include: positioning of the patient, suctioning, and the rehabilitation of muscle strength once the patient has recovered from the condition and are now focusing on returning to their original state. 

Positioning

According to many recent studies, the most effective position in treating ARDS is prone. The dependent lung is compressed when lying in supine, Based on reviewing a list of studies on ARDS treatment, a suggested procedure has been described by Hough (2014)

Prevention

Brief consideration of how this pathology could be prevented and the physiotherapy role in health promotion in relation to prevention of disease or disease progression.

Resources

NHS - Acute Respiratory Distress Syndrome

Scholarly Article: Acute Respiratory Distress Syndrome Treatment & Management 

Video: https://www.youtube.com/watch?v=ndrXtRmVkmE