Acute Respiratory Distress Syndrome (ARDS) and Acute Respiratory Failure (ARF)

Acute Respiratory Distress Syndrome (ARDS)

• Definition: Respiratory failure due to non-cardiac pulmonary edema.

  • Unlike left-sided heart failure which results in pulmonary edema, ARDS results from direct or indirect lung injury.
  • Leads to systemic inflammation, increased alveoli permeability, fluid collection in lungs.

• Risk Factors:

  • Sepsis
  • Shock
  • Trauma
  • Pneumonia
  • Pancreatitis
  • Inhalation of chemicals or near-drowning

• Signs and Symptoms:

  • Dyspnea (difficulty breathing)
  • Rapid and shallow breathing
  • Substernal retractions
  • Tachycardia (fast heart rate)
  • Cyanosis or pallor
  • Crackles in lungs due to fluid

• Diagnosis:

  • Use of ABGs (Arterial Blood Gases)
  • Chest X-ray showing bilateral infiltrates

• Treatment:

  • Correct underlying cause
  • Administration of oxygen
  • Mechanical ventilation if necessary

• Nursing Care:

  • Maintain patent airway
  • Monitor cardiac status
  • Provide mechanical ventilation care

Acute Respiratory Failure (ARF)

• Definition: Inability of lungs to maintain arterial oxygenation or to eliminate carbon dioxide, resulting in tissue hypoxia.

• Risk Factors:

  • Atelectasis (lung collapse)
  • COPD (Chronic Obstructive Pulmonary Disease)
  • Cystic Fibrosis
  • Heart Failure
  • Pneumonia
  • Pneumothorax (collapsed lung)
  • Pulmonary embolism

• Signs and Symptoms:

  • Respiratory distress
  • Tachycardia
  • Dysrhythmia (irregular heartbeat)
  • Signs of hypoxia
    • Early signs: Restlessness
    • Late signs: Decreased level of consciousness

• Treatment:

  • Oxygen therapy
  • Mechanical ventilation
  • Chest physiotherapy
  • BiPAP and CPAP
  • Medications: Bronchodilators, corticosteroids, antibiotics, inotropic agents (e.g., digoxin), vasopressors, diuretics

• Nursing Care:

  • Maintain patent airway (top priority)
  • Promote effective positioning
    • Head of the bed up at least 30 degrees
    • "Good lung down" positioning
    • Prone positioning for effective oxygenation
  • Encourage coughing, deep breathing, and increased fluid intake for non-intubated patients
  • Monitor ABGs, inputs and outputs (I&O), fluid and electrolytes, cardiac status