By Acute Respiratory Distress Syndrome, physicians mean acute respiratory failure of the patient. This sudden onset of respiratory distress is also known by the abbreviated name ARDS. The condition must have an identifiable and noncardiac underlying cause.
What is acute respiratory distress syndrome?
By Acute Respiratory Distress Syndrome, physicians mean acute lung failure in the patient. This so-called shock lung is caused by an inflammation of the lung tissue, which can be caused by different impacts. The consequences if not treated in time can be: shock conditions, unconsciousness up to organ failure and heart failure. Acute Respiratory Distress Syndrome refers to the severe reaction of the lungs to various damaging factors. Acute Respiratory Distress Syndrome is characterized by multifactorial damage to the lungs with the development of pulmonary edema and consecutive oxygenation disturbance. Acute respiratory distress syndrome, or shock lung, describes a sudden shortness of breath caused by lung injury. The affected person gets very poor air, causing an increase in the amount of carbon dioxide in the blood and a decrease in the amount of oxygen. The possible consequences of not receiving timely treatment include: Unconsciousness, shock, and even organ and heart failure.
Causes
The cause of Acute Respiratory Distress Syndrome is inflammation of the lung tissue, which can be caused by various agents. The antecedents can be quite diverse, for example, pneumonia, injury, poisoning. The main causes include inhalation of harmful substances, for example, smoke or aspiration of various substances, for example, gastric fluid. Indirect effects such as clotting disorders or injuries can lead to Acute Respiratory Distress Syndrome. This results in pulmonary edema, because within the alveoli the permeability of the blood vessels increases. This leads to a drop in pressure in some vascular areas of the lung tissue. At the same time, a pressure increase occurs in other parts. In addition, proteins leak out, significantly decreasing the oxygen supply to the blood and increasing the carbon dioxide content.
Symptoms, complaints and signs
Acute Respiratory Distress Syndrome develops in most cases about 24 to 48 hours after the initial injury or illness occurred. The affected person initially experiences shortness of breath, usually accompanied by rapid, shallow breathing. The physician may hear crackling or wheezing in the lungs with a stethoscope. Because of low oxygen levels in the blood, the skin may appear blotchy or blue (cyanosis). Other organs, such as the heart and brain, may malfunction, for example, a rapid heart rate, arrhythmia, confusion and lethargy.
Diagnosis and course
Acute respiratory distress syndrome, or acute respiratory failure, usually begins with the following symptoms: because of the damage to the lung tissue, the patient initially feels difficulty breathing. He begins to breathe faster so that he can counteract it. This leads to hyperventilation. The lips and fingernails may turn blue after some time. Medical experts distinguish between three phases:
- In the first phase, due to the damage to the tissue, the biochemical process occurs.
- In the second phase, the symptoms intensify. As a result, in the third phase, the affected person only has a lung volume equivalent to an infant.
Due to the inflammation, most of the lung tissue has ceased to function. Depending on the extent, the low oxygen level can have various consequences, ranging from unconsciousness, shock, organ failure and heart failure. The physician usually makes the diagnosis of ARDS in terms of previous illness. Listening to the lungs reveals the first signs, as a rattling sound is perceived here. A subsequent X-ray examination can provide a more precise diagnosis. This shows any deposits in the alveoli, which can be a clear indication of the onset of shock lung.
Complications
Adult acute respiratory distress syndrome, often referred to as shock lung, is associated with an extreme inflammatory response of the lungs and lung tissue. This causes a pathological chain of reactions that leads to a number of complications. First, pulmonary edema often forms due to the inflammation-induced lung damage. This is caused by an increase in the permeability of the capillaries. This inflammatory reaction also leads to the immigration of certain white blood cells, which release lytic enzymes and oxygen radicals, thus exacerbating the original inflammation. If the patient is not treated or is not treated successfully, these inflammatory mediators cause the permeability of the capillaries to increase further in the next stage. This often results in alveolar edema, i.e., edema affecting the alveoli. In the next stage, the surfactant, a kind of protective substance on the alveoli, is destroyed. This leads to further severe complications. As a rule, the consequence is atelectasis, i.e. a ventilation deficit of the lungs or individual parts of the lungs. As a result, oxygenation of the blood and thus the oxygen supply to the brain and other organs is extremely impaired. At this stage, respiratory distress syndrome is usually fatal. If the patient survives, there are usually further complications in the healing process. Often, the body can only replace the destroyed lung tissue with connective tissue. As a result, the oxygen supply to the body is permanently reduced.
When should you see a doctor?
In the case of acute “respiratory distress” syndrome, i.e. acute shortness of breath due to the onset of lung failure, an immediate visit to the doctor or the immediate calling of the emergency physician is essential. This is a relatively sudden onset of lung failure that must be treated immediately. The so-called shock lung can lead to death within a short time if left untreated. Acute respiratory distress syndrome is a dramatic emergency situation. The affected person is likely to quickly become unconscious due to the shock-like onset of respiratory distress. Without medical assistance, the patient will not be able to survive this emergency. On the one hand, the affected person must be ventilated immediately so that the carbon dioxide level in the blood drops. For another, the cause of Acute Respiratory Distress Syndrome must be determined as quickly as possible. This can best be done in a clinic where the sufferer will be given all the medical help he or she needs. The attending physician may be aware of pre-existing conditions that could be triggers. Otherwise, testimony from bystanders who know what happened in the 24-48 hours before the onset of respiratory distress and respiratory failure is important for history taking. Quick action is especially important in Acute Respiratory Distress Syndrome to prevent worse damage to the failing lung. Complications can be expected if there are delays.
Treatment and therapy
Therapy for Acute Respiratory Distress Syndrome is intensive medical. Within a few hours, the condition can lead to respiratory decompensation with a need for ventilation. Decompensation occurs when a body can no longer compensate for the defects created by a disease. The first priority is to treat the precipitating cause and start mechanical ventilation early. When patients are ventilated, there is often only a small pressure amplitude available to shift the respiratory volume. As a result, hypercapnia may occur. In individual cases, this must be tolerated. However, patients with increased intracranial pressure are an absolute contraindication. Therapeutic options to prevent hypercapnia include high-frequency oscillation and extracorporeal lung support with a heart-lung machine. Because of the increased risk of thrombosis during immobilization, low-dose heparin should be
low-dose heparinization should be given concomitantly. If feasible, the patient is fed enterally via a central venous catheter or gastric tube. Often, both forms of nutrition must be used. The therapy requires an intensive medical effort. Late in the course, at the stage of healing, the administration of glucocorticoids can reduce pulmonary fibrosis.
Outlook and prognosis
Acute respiratory distress syndrome is a very serious and dangerous condition for the patient and usually leads to death without treatment. Severe respiratory distress occurs, which is often accompanied by a panic attack. Furthermore, without treatment, direct failure of the lungs can occur. This means that organs are not supplied with sufficient oxygen and can be damaged. In the worst case, cardiac arrest occurs. In most patients, Acute Respiratory Distress Syndrome also causes hyperventilation and further loss of consciousness. The further course of the disease depends very much on the cause of Acute Respiratory Distress Syndrome and on its treatment. Acute treatment by the emergency physician can relieve most of the symptoms and save the patient. Without treatment, the patient will die after a few minutes. If the air supply has been interrupted for a few minutes, various damages to the organs may have developed. In some cases, this results in paralysis or spasticity.
Prevention
The optimal way to prevent Acute Respiratory Distress Syndrome is to intensively treat the underlying disease that can lead to acute respiratory failure. This is imperative so that it does not lead to respiratory failure. If lung failure does occur, it is important that it is detected in time to prevent serious consequences. Therefore, it is very important that the physician consider shock lung at the first signs of respiratory distress for which there is no explanation. Shock lung is acute, life-threatening damage to the lungs. Therefore, if symptoms are unusual, a medical professional should always be consulted to determine the cause of the symptoms.
Follow-up
Acute respiratory failure is always a life-threatening condition. Patients with Acute Respiratory Distress Syndrome rarely experience the need for medical follow-up because of the dramatic nature of the event. A high number of affected individuals die as a result of multiple organ failure. Often, a systemic inflammatory process – a Systemic Inflammatory Response Syndrome or SIRS – is present at the same time. Acute Respiratory Distress Syndrome can present in three degrees of severity. These are treated with varying degrees of intensity. The causes of ALRS are numerous. Accordingly, mild Acute Respiratory Distress Syndrome may require different follow-up than moderate severity. In severe cases with advanced sepsis, after severe burn injuries or traumatic brain injury, death is almost always inevitable. In some cases, even an already advanced Acute Respiratory Distress Syndrome can be survived by self-healing mechanisms of the organism. However, despite all intensive medical interventions, severe lung damage usually remains in the surviving patients. These require permanent follow-up care. Acute respiratory distress syndrome survivors are often ventilator dependent. They are significantly more susceptible to pneumonia, pulmonary fibrosis, or sepsis. Mortality rates range from 55 to 70 percent. Permanently bedridden ARDS patients have little protection against the development of thrombosis and embolism. Follow-up care must take into account the high risk level of those affected.
Here’s what you can do yourself
Individuals suffering from acute respiratory distress syndrome must be treated immediately by an emergency physician. Until emergency medical services arrive, the affected person must be placed in the prone position and sedated. In the event of respiratory or cardiac arrest, resuscitation measures must be taken, such as mouth-to-mouth resuscitation or the use of a defibrillator. Acute Respiratory Distress Syndrome is a serious syndrome that requires medical treatment in all cases. The affected person must spend some time in the hospital after the emergency. If the outcome is positive, light physical activity can be resumed a few days to weeks after the procedure. Accompanying this, the causes of the medical emergency must be determined and remedied.Since acute respiratory distress syndrome is always the consequence of a protracted illness or a serious accident, treatment focuses on symptomatic therapy, since causative treatment is usually no longer possible. Curative or palliative medical measures can be supported by general measures such as physiotherapy, a diet, and discussions with an appropriate therapist.
