Acute Respiratory Distress Syndrome (ARDS)

Dr. Nabi Darya Vali (AIIMS)MBBS

June 18, 2020

June 04, 2022

Acute Respiratory Distress Syndrome
Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) is a life-threatening condition that occurs due to sudden inflammation in the lungs—this leads to respiratory failure and low oxygen levels in the blood (hypoxemia). This condition is also known as acute lung injury and adult respiratory distress syndrome, as described by a study in 1967.

ARDS occurs when there is a collection of fluid in the air sacs in the lungs, which are also known as alveoli. As it happens with other respiratory illnesses, fluid collection in the lungs leads to low oxygen supply in the bloodstream or an increase in carbon dioxide in the body, which stops the otherwise regular supply of oxygen to different organs in the body.

The onset of ARDS has been known to be rather sudden, or at best, developing over just a few days. It typically presents with shortness of breath as a key symptom. Laboured or extremely fast breathing and clicking or bubbling sounds coming from the lungs have also been described as common signs when a patient develops ARDS.

While the disease can develop at any age, the onset of such a condition among preterm babies (born before 37 weeks of gestation) or newborns is known as respiratory distress syndrome (RDS) or neonatal respiratory distress syndrome. In the case of ARDS, the condition usually develops due to another underlying condition, or a sudden trauma that resulted in difficulty breathing.

Types of ARDS

As mentioned above, ARDS is known as respiratory distress syndrome among infants and newborns. 

Whether it is seen in adults or babies, the cause is sudden and severe inflammation in the lungs.

ARDS may be mild, moderate or severe, depending on the volume of oxygen that is available in the blood.

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ARDS symptoms

Some of the common symptoms of ARDS become visible within one to three days of a trauma or a debilitating condition:

  • Difficulty breathing or shortness of breath
  • Rapid or laboured breathing
  • Low blood pressure
  • Dry cough
  • Frequent headaches
  • Rapid pulse
  • Confusion
  • Fatigue
  • Fever
  • Pain in the chest when trying to breathe deeply
  • Discolouration of the skin on the fingernails, lips or toenails

Read more: First aid for difficulty breathing

ARDS causes

The onset of ARDS can be due to the following factors:

  • A sudden physical injury: For example, after a road accident which damages the lungs or the part of the brain that regulates breathing.
  • Breathing in toxic substances: Inhalation of dense smoke or fumes emerging from a chemical factory, saltwater or even vomit.
  • Sepsis is a blood infection. It can cause inflammation and obstruct the flow of oxygen through the body.
  • Infections such as COVID-19 and pneumonia: Several studies of late have also pointed to the development of ARDS among patients with COVID-19 symptoms.
  • An overdose of sedatives or antidepressants.

Apart from the above-mentioned factors, certain people are at a higher risk of developing ARDS as well:

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Prevention of ARDS

The key to managing ARDS in a person is early diagnosis, and even though the condition is not fully preventable, certain lifestyle changes and being alert about your own personal health is a good way to keep sudden and severe conditions such as ARDS at bay. Here are a few tips:

  • Quit smoking, passive smoking and alcohol use, as these can reduce lung function drastically.
  • Get vaccinated for flu and pneumonia regularly as it helps prevent frequent infections in the lungs.
  • Seek immediate medical help in the case of infections, illnesses, trauma or physical injuries.
  • You could also get a pulse oximeter to test your blood oxygen saturation at home—a reading of 95% or more on the battery-operated machine means you're not in any respiratory distress.

Diagnosis of ARDS

Because the onset of ARDS is sudden and can occur due to an accident, calling emergency services is the first step to getting the patient adequate care. ARDS can be difficult to diagnose as its symptoms are quite similar to other respiratory illnesses, hence it is important to know the history of your symptoms.

ARDS is a medical emergency. Doctors may run several tests to ensure early diagnosis, which can be critical for the patient's survival. Any of these could help find the root cause:

The ECG and echo tests are usually performed to rule out heart conditions that may be causing breathing difficulties in a patient, while imaging tests such as X-rays and CT scans are helpful in looking at the air sacs in the lungs, which may be filled with fluid.

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ARDS treatment

One of the first ways to tackle ARDS is to increase the level of oxygen in the bloodstream, to allow the various organs in the body to continue functioning. Here are the ways it can be done:

  • Supplemental oxygen: In the case of mild to moderate ARDS, supplemental oxygen delivered through a mask while breathing can provide relief to the patient experiencing breathing difficulties. (Read more: What is oxygen therapy?)
  • Ventilation: ARDS develops quite suddenly, and ventilator support may be required for an ARDS patient to be able to breathe. A ventilator also helps in pushing the fluid out of the air sacs in the lungs.
  • Fluid management: By controlling the volume of fluids and electrolytes in the body, doctors can manage ARDS. (Read more: What is fluid therapy?)
  • Medicines: Pain medications, antibiotics for the underlying condition, blood thinners to avoid blood clots are all medications that are used to control the effects ARDS may have on the body.
  • Pulmonary rehabilitation: A more long-term treatment plan includes a patient restoring the functioning of their lungs or increasing lung capacity by making lifestyle changes, following an exercise and diet plan, controlling fluid intake that can help improve the quality of life of a patient.

According to the American Lung Foundation, 30% to 50% of patients with ARDS do not have a favourable outcome, but mortality risk is largely dependent on the patient's overall health, age and many other factors. Preventive measures such as changes in lifestyle and frequent medical checkups, along with a regular exercise regimen can help some patients lead a healthy life.

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  1. National Health Service [Internet]. UK; Acute respiratory distress syndrome.
  2. Columbia University Irving Medical Center [Internet]. New York, USA. Acute Respiratory Distress Syndrome (ARDS).
  3. Diamond M et al. Acute Respiratory Distress Syndrome (ARDS). StatPearls Publishing. 2020 Jan. PMID: 28613773.
  4. National Heart, Lung and Blood Institute: National Institutes of Health; [Internet]. U.S. National Library of Medicine. Acute Respiratory Distress Syndrome.
  5. American Lung Association. [Internet]. Chicago. Learn About ARDS.
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