Causes and Nursing Management of Acute Respiratory Distress Syndrome

Definition of Acute Respiratory Distress Syndrome (ARDS):

ARDS (acute respiratory distress syndrome) may be defined as acute, diffuse pulmonary inflammatory response to either direct (via airway or chest trauma) or indirect blood-borne insults that originate from extra pulmonary pathology. It is frequently associated with other organ dysfunction (kidney, heart, gut, liver, coagulation) as a part of multiple organ failure.

Acute respiratory distress syndrome (ARDS)
Fig: Acute respiratory distress syndrome (ARDS)

It is characterized by-

  • Neutrophil sequestration in pulmonary capillaries.
  • Increased capillary permeability, protein-rich pulmonary oedema with hyaline membrane formation.
  • “Damage to type 2 pneumocytes leading to surfactant depletion.
  • Alveolar collapse and reduction in lung compliance.

The criteria defining ARDS are:

  • Hypoxaemia defined as Pa02/ F102( <200 mmHg).
  • Chest radiograph showing diffuse bilateral infiltrates.
  • Absence of a raised left atrial pressure.
  • Impaired lung compliance.

Causes of ARDS /Conditions Predisposing to ARDS:

A. Inhalation (direct):

B. Blood-borne indirect):

  • Sepsis,
  • Necrotic tissue (particularly bowel),
  • Multiple traumas,
  • Pancreatitis,
  • Cardiopulmonary bypass,
  • Severe burns,
  • Drugs (heroin, barbiturates, thiazides),
  • Major blood transfusion reaction,
  • Anaphylaxis (wasp, bee, snake venom),
  • Fat embolism,
  • Carcinomatosis,
  • Obstetric crises (amniotic fluid embolus, eclampsia).

How will You Manage a Case of Acute Respiratory Distress Syndrome (ARDS)?

Management of Acute Respiratory Distress Syndrome (ARDS):

Clinical Features of Acute Respiratory Distress Syndrome (ARDS):

  • Rapidly progressive dyspnoea,
  • Tachypnoea.
  • Central cyanosis, refractory to 02 therapy.
  • Bilateral crepitation, inspiratory rhonchi
  • Intercostal indrawing.


  1. Chest x-ray:
  • Bilateral, diffuse fluffy shadow,
  • Ground glass appearance in lung fields.
  1. Arterial blood gas analysis.
  2. Left atrial pressure measurement.

Treatment of Acute Respiratory Distress Syndrome (ARDS):

A. Supportive Rx:

a) Rest with propped up position

b) Oxygen inhalation with high inflation pressure & high conc. 02,

c) Positive end expiratory pressure (PEEP) by mechanical ventilation.

d) High dose of corticosteroid

e) Inhalation of nitric oxide may improve gas exchange.

B. Early & effective treatment of precipitating cause.


  • Acute left ventricular failure (LVF),
  • Lung fibrosis.

Nursing Management of Acute Respiratory Distress Syndrome (ARDS):

Nursing assessment:

  • Assess and note dyspnea, tachypnea, internal-muscular traction, fatigue, or pulmonary edema.
  • Assess breath sounds.
  • Assess the level of consciousness and ability to tolerate increased work of breathing,
  • Assess the signs of hypoxemia and hypercapnia.

Nursing diagnosis:

  • Ineffective breathing pattern,
  • Impaired Gas Exchange,
  • Ineffective airway clearance,
  • Decreased Cardiac Output,
  • Risk for Injury,
  • Excess Fluid Volume,
  • Impaired Verbal Communication,
  • Impaired Physical Mobility,
  • Impaired Skin Integrity,
  • Sleep Pattern Disturbance,
  • Ineffective Coping.

Expected outcomes:

  • Stating/show loss of dyspnea.
  • Maintain a patent airway with breath sounds clean / no crackles.
  • Issued a secret without difficulty.
  • Show behavior to improve/ maintain airway clearance.

Nursing intervention:

  • Maintain a patent airway by suctioning. Use sterile, non-traumatic technique.
  • Ensure adequate humidification to help liquefy tenacious secretions.
  • Provide any other means of communication for the patient on mechanical ventilation.
  • Gives sedatives as ordered to reduce restlessness.
  • Reposition the patient often. A high fowler position may be needed.
  • Note and record any changes in respiratory status, temperature, or hypotension that may indicate a deteriorating condition.
  • Record caloric intake. Administer tube feedings and parenteral nutrition as ordered.
  • To promote health and prevent fatigue, arrange the alternate periods of rest and activity.
  • Maintain joint mobility by performing passive range-of-motion exercises.
  • Provide meticulous skin care to prevent skin breakdown.
  • Provide emotional support.
  • Monitor the patient’s level of consciousness, noting confusion or mental sluggishness.
  • Closely monitor the patient’s heart rate and blood pressure
  • Frequently evaluate the patient s serum electrolyte levels.
  • Monitor and record the patient’s response to medication.
  • Evaluate the patient’s nutritional intake.

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