ARDS (cont.)
How is ARDS Diagnosed?
Doctors diagnose acute respiratory distress syndrome (ARDS) when:
- A person suffering from severe infection or injury
develops breathing problems.
- A chest x ray shows fluid in the air sacs of both
lungs.
- Blood tests show a low level of oxygen in the blood.
- Other conditions that could cause breathing problems have been ruled
out.
ARDS can be confused with other illnesses that have
similar symptoms. The most important is congestive heart failure. In congestive
heart failure, fluid backs up into the lungs because the heart is weak and
cannot pump well. However, there is no injury to the lungs in congestive heart
failure. Since a chest x ray is abnormal for both ARDS and congestive heart failure, it is sometimes very
difficult to tell them apart.
How is ARDS Treated?
Patients with acute respiratory distress syndrome (ARDS) are usually treated
in the intensive or critical care unit of a hospital. The main concern in
treating ARDS is getting enough oxygen into the blood until the lungs heal
enough to work on their own again. The following are important ways that ARDS
patients are treated.
Extra Oxygen
The main treatment is giving a higher concentration of oxygen than that found
in normal air—that is, enough to raise blood levels of oxygen to safe levels.
This can sometimes be done with a face mask. A face mask can deliver oxygen at a
concentration of 40-60 percent. As the ARDS progresses over hours or days, the
patient may need a higher level of oxygen than a face mask can give.
If the patient becomes tired from breathing so hard, it may become necessary
to connect the patient to a breathing machine (ventilator). This can
be done by placing a tube through the mouth or nose into the windpipe (trachea)
in a procedure called endotracheal intubation (or just intubation) and
connecting the tube to the ventilator. Sometimes the connecting tube is inserted
through a surgical opening in the neck (this procedure is called a tracheotomy). The
breathing machine can be set to help or completely control breathing. It will
deliver the minimum amount of air every minute. If the extra oxygen and help
with breathing are not enough, the breathing machine can be set to Positive End
Expiratory Pressure (PEEP) to maintain the surface for gas exchange.
PEEP keeps some air in the lungs at the end of each breath. It helps keep the
air sacs open instead of collapsing. The setting on the breathing machine can be
adjusted to fit the needs of the patient. Other settings on the breathing
machine control the number of breaths per minute (rate control) and the amount
of air the ventilator uses to inflate the lungs in each breath (tidal volume).
Medicines
Many different kinds of medicines are used to treat ARDS patients. Some kinds
of medicines often used include:
- Antibiotics to fight infection
- Drugs to relieve anxiety and keep the patient calm and
from "fighting" the breathing machine
- Drugs to raise blood pressure or stimulate the heart
- Muscle relaxers to prevent movement and reduce the body's demand for
oxygen
Other Treatment
With breathing tubes in place, ARDS patients cannot eat or drink as usual.
They must be fed through a feeding tube placed
through the nose and into the stomach. If this does not work, feeding is done
through a vein. Sometimes a
special bed or mattress, such as an airbed, is used to help prevent
complications such as pneumonia or bedsores. If complications occur, the patient
may require treatment for them.
Results
With treatment:
- Some patients recover quickly and can breathe on their
own within a week or so. They have the best chance of a full recovery.
- Patients whose underlying illness is more severe may
die within the first week of treatment.
- Those who survive the first week but cannot breathe on their own may
face many weeks on the breathing machine. They may have complications and a
slow recovery if they survive.
Next: Recovering from ARDS »
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