Acute Respiratory Distress Syndrome (ARDS): What to Know

Acute respiratory distress syndrome (ARDS) is a serious complication you could experience after some types of respiratory infections or trauma. When this complication develops, your lungs become inflamed and can fill with fluid and secretions that make breathing even more difficult.

This article will review some of the causes of ARDS and what to expect if you develop this problem.

What Is Acute Respiratory Distress Syndrome?

ARDS is a severe respiratory condition that causes severe lung inflammation, limiting blood oxygenation and waste exchange.

Your lungs contain tiny sacs called alveoli that fill with air each time you breathe, allowing oxygen to move from the air you breathe into your bloodstream and moving gaseous waste gases out of your blood through exhalation.

With ARDS, swelling and inflammation can cause these alveoli to become stiff, then burst and leak fluid, limiting how much oxygen and waste gases can be exchanged between your blood and the air you breathe.

ARDS can develop suddenly or over several days and usually progresses through the following three phases.

• Exudative phase: The first phase occurs following the initial injury or illness that triggered ARDS. During this phase—which lasts up to 10 days—inflammation and swelling build, and lung tissue is damaged.
• Proliferative phase: The second phase of ARDS is when the lung tissues slowly heal and reform, and anti-inflammatory cells remove fluid and infectious debris. The proliferative phase lasts two to three weeks.
• Fibrotic phase. The third and final phase doesn't happen for everyone. However, those who recover from ARDS may develop permanent changes, such as inflammation and intermittent lung tissue stiffening, after recovery.
  

Is ARDS Contagious?

ARDS is not contagious because it's not an infection. Instead, it's a severe but delayed reaction to a previous illness or injury. However, if you've developed ARDS from a respiratory infection, you may still be contagious with that illness and could pass it to others. But the ARDS response alone is not contagious.

What Causes ARDS?

ARDS is your body's inflammatory immune response after an initial infection or injury. There are many possible triggers of ARDS, but the most common underlying causes include things like:

• Pneumonia (either bacterial or viral)
• Sepsis (a severe bacterial infection in the blood)
• Aspiration (when fluids are inhaled into the lungs)
• Severe trauma or injury

If you develop ARDS after an infection, your healthcare provider will continue to treat the underlying illness or injury as well as the effects of ARDS.

ARDS Risk Factors

Anyone can develop ARDS, but certain people are at a higher risk than others.

Some things that can increase your risk of developing ARDS after an injury or infection include:

• Specific infections like the virus that causes COVID-19 (SARS-CoV-2)
• Cigarette smoking
• Heavy alcohol use
• Exposure to air pollution and other environmental toxins
• Genetics and a family history of lung diseases
• Prior heart or lung surgeries
• Pancreatitis

Symptoms of ARDS

The symptoms you experience leading up to ARDS can depend on the triggering event. You may have symptoms of a respiratory infection if your ARDS is caused by pneumonia, but sepsis and trauma could cause symptoms to develop suddenly.

The main symptoms specific to ARDS are severe shortness of breath (dyspnea) and a low oxygen level in your blood (hypoxemia).

Complications From ARDS

ARDS can lead to acute respiratory failure. When this happens, the injury and damage in your lungs are so severe that you may not be able to breathe on your own without support.

Symptoms of acute respiratory failure can include:

• Shortness of breath
• Low blood oxygen levels
• Blue-hued lips and fingernails
• A crackling sound in the lungs
• Fatigue or weakness
• Shallow breathing
• Chest pain
• Increased heart rate
• Low blood pressure
• Confusion

If you're experiencing any of the above symptoms, seek emergency medical attention. Failure to treat ARDS effectively at this stage could put you on a path for additional complications like permanent lung damage, blood clots, multiple organ failure, and even death.

How ARDS Is Diagnosed

Your healthcare team will diagnose ARDS after reviewing several measures, including your respiratory rate and oxygen saturation level. A chest X-ray is the primary diagnostic tool that helps differentiate ARDS from other heart and lung problems. Your healthcare provider will look at the X-ray for visible inflammation on both sides of the chest without another known cause.

Your healthcare team may do additional testing to rule out other chronic heart or lung issues that could cause lung fluid buildup.

Treating and Managing ARDS

Although ARDS treatment may target the underlying injury or infection, the inflammatory response and accompanying respiratory failure are treated separately. The overall goal of ARDS treatment is to support your breathing while your lung tissue heals and recovers.

Oxygen

Oxygen therapy is the primary treatment for ARDS. Your damaged alveoli can't move oxygen into your bloodstream effectively, so your healthcare team will focus on increasing the amount of oxygen in your tissues.

This can mean a small amount of oxygen through a nasal cannula, higher flow devices, or even mechanical ventilation through a breathing tube in your mouth. If you require a ventilator to manage your ARDS, your healthcare team will customize the pressure and oxygen levels to support your oxygen requirements and promote lung healing.

Managing Fluids

With fluids already building in your lungs during ARDS, your healthcare provider may also treat you with medications like diuretics to help remove extra fluid and swelling from your body. You may also receive intravenous fluids or fluids and nutrition through a feeding tube if you need ventilator support for more than a few days.

Medication

You may already be receiving antiviral or antibiotic medications to treat the condition that triggered your ARDS. However, your healthcare provider may administer additional medications as needed, such as blood thinners to prevent blood clots and steroids to reduce inflammation.

Pulmonary Rehabilitation

Even after recovery from ARDS, you will likely need ongoing therapy to regain your previous lung function. This may include physical therapy, breathing exercises, and ongoing respiratory support.

Long-Term Outlook for ARDS

People who survive ARDS may continue to experience adverse impacts on their quality of life. Lung function may eventually return to normal (usually within five years), but there are other long-term effects on your body.

The therapies used to treat ARDS—such as mechanical ventilation and proning—are also difficult to endure, and survivors may struggle with psychological issues like post-traumatic stress disorder (PTSD) even after recovery.

Can You Prevent ARDS?

Not every episode of ARDS can be prevented entirely, but if you fall into one of the high-risk categories, you can take steps to minimize your chances of developing ARDS. This may include things like:

• Quitting smoking
• Avoiding secondhand smoke or air pollution
• Getting vaccinated against common respiratory viruses

If you know you have a high risk of developing ARDS, it's also essential to address any respiratory infections early and seek treatment from a healthcare provider.

When to Contact a Healthcare Provider

Not every respiratory infection requires treatment by a medical provider, but you should always seek medical care if:

• You become so short of breath that you can't complete a sentence
• Your lips or nail beds take on a blue or gray color
• You become light-headed, dizzy, or confused
  

Summary

ARDS is a serious complication that can develop after a severe respiratory infection or injury. It happens when the tiny air sacs in your lungs get damaged, burst, and can't effectively move oxygen into your bloodstream. ARDS often requires mechanical ventilation and other invasive treatments, and mortality rates are high.

Even after recovery, you may have ongoing breathing issues. Talk to a healthcare provider about your risk factors for ARDS and what you can do to prevent it.