Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome commonly known as ARDS is a life-threatening medical condition whereby the lungs cannot provide sufficient oxygen for the body.
Causes
This condition develops when the lungs has become infected or sustained an injury leading to inflammation. The inflammation causes fluid from nearby blood vessels to leak into the tiny air sacs in the lungs, making breathing increasingly difficult.
 Inflammation can be caused by:

• Sepsis
• Pneumonia
• Severe chest injury  
• Accidental inhalation of vomit, smoke or toxic chemicals
• Acute pancreatitis
• Blood transfusion reaction

Clinical Features
Theses can occur within 24 to 48hrs of illness and can include:

• Severe shortness of breath
• Rapid, shallow breathing
• Low blood pressure
• Tiredness, drowsiness or confusion
• Feeling faint
• Organ failure

Normally, these patients are so sick that they cannot complain of symptoms.

Diagnosis

A full assessment is carried out and include the following:

• Physical examination
• Blood test to ascertain oxygen saturation and check for signs of infection
• Arterial blood gases(ABG) for continous monitoring of respiratory state, blood volume and electrolytes.
• Blood and urine culture
• Pulse oximetry test for continuous monitoring of oxygen saturation
• Chest X-ray and a computerised tomography (CT) scan – to look for evidence of ARDS
• Echocardiogram to picture the heart ; to rule out heart failure.
• Sputum culture and analysis
• Broncoscopy can be carried out in certain cases.

Treatment
-Admission into intensive care unit for breathing support via Ventilator. 
-Antibiotic administration to fight infection.

My Encounter with ARDS
I had to look after after a Mr. X diagnosed with ARDS and Intracranial hyperosmolar. It turned out to be a very busy and interesting shift.   

• Cardiovascular: Blood pressure was initially high but was supported with Noradrenaline infusion and it was managed. - Mean arterial pressure (MAP) target was above 70mmhg  - Heart rate was sinus rhythm -Central venous pressure showed that he was well  filled. 

• Respiratory: Was intubated and ventilated. Settings include: pressure control mode of 24, peep 14, FiO2 70%, respiratory rate 15,  peak 38. The above high settings were changed slightly throughout the day. ABG revealed; high PCO2, low O2, high hydrogencarbonate, high base excess, high sodium, low potassium and high glucose. All electrolytes were replaced and a slidiing scale was in place to control his blood glucose level.

• Neurologically, he was sedated and paralysed using Propofol and Actracurium infusions.  Fentanyl was given for pain. Pupils were 2 and nonreactive. Richmond sedation agitation score was -5(deeply sedated and unarousable)

• Nutrition: on nasogastric feed- Nutrison  and ng water at 40ml and 30ml respectively as he had high sodium.

• Elimination: Good bowel movement and urine output. However, furosemide was given to push more fluid out of the lungs. 

I hope you are getting the gist? I am not going to bore you with my nursing care bits. So, let me wrap it up by telling you the issues and plan for that day. 
Problems:

• ARD
• Septic shock
• Neutral fluid balance(off target)
• Electrolyte abnormalities
• Permissive hypercapnia

Plan:

PC Ventilator settings - sedated and paralysis

Manual recruitment post sunctioning

No nebs - Suction 6hrly

Ng water @ 30ml/hr

Furosemide infusion Urine output greater than 100ml/hr

Continue antibiotics Meropenem and Teicoplanin

Discuss with microbiology daily.

Lastly, .ARDS is a killer illness. I was practically on my feet throughout the shift as Mr. X was unstable and I had lots of infusions that were running out at different times amongst other tasks. Suctioning was quite scary that day as Mr. X could desaturate within secs. Oh! I ended up staying 45mins extra to do my documentations.

References 
NHS Choices (2015) Acute respiratory distress syndrome  http://www.nhs.uk/conditions/acute-respiratory-distress-syndrome/Pages/Introduction.aspx Accessed 29th Oct. 2016.

MedilinePlus (2016) Acute respiratory distress Syndrome https://medlineplus.gov/ency/article /000103.htm  Accessed 4th Nov 2016.

P.S.
Thanks for reading. Sorry for the medical jargons- I tried to minimse them. When your loved ones or friends are sick or look unwell, please encourage them to go the hospital to get a medical assistance.Ours lives are so precious. 

Disclaimer: This cannot substitute for a professional medical advice and treatment.