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Ards (Adult Respiratory Distress Syndrome)

Overview

This condition is a failure of the respiratory system characterized by fluid accumulation within the lung that causes the lung to stiffen. The condition is triggered by a variety of processes that injure the lungs.

When we breathe, air enters into our lung and then into alveoli. Alveoli are the air filled sacs in the lungs which are used for exchange of air between capillaries, around the alveoli and alveoli. In this disease there is disturbance in the normal process of gas exchange and causes decreased oxygen content in the blood, called Hypoxia. This will affect multiple organs and cause multiple organ failure. ARDS is defined as the ratio of arterial partial oxygen pressure (pressure in the arteries due to oxygen) to the fraction of the inspired oxygen. This ratio is below 300 mm of Hg in ARDS, while it is below 200mm of Hg in acute lung injury which is a precursor form of ARDS. The onset is rapid and it is a collection of so many symptoms and hence called as syndrome. Oxygenation of lung gets severly impaired.


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Causes

In this condition, as the there is inflammation in the lung parenchyma, there is infiltration of the inflammatory fluid in the parenchyma, and no proper oxygenation and blood flows to the pulmonary vein. So, there is a back flow of blood to the right venticle from the pulmonary artery. This results in shunting of the blood from the right to the left side of the heart. This disease does not originate from the heart itself but from some malfunctioning of the lungs. So, it is also called non cardiogenic oedema. Some conditions which can directly or indirectly lead to the some injury to the lung can cause respiratory symdrome. The following conditions can develop acute respiratory distress syndrome:-

  • Pneumonia. This is an infection in the lungs.
  • Breathing in harmful fumes or smoke.
  • Inhaling vomited stomach contents from the mouth.
  • Severe acute respiratory syndrome (SARS). This is a type of pneumonia.
  • Using a ventilator. This is a machine that helps people breathe, but, rarely, it can injure the lungs.
  • Nearly drowning.
  • Drug overdose.
  • An injury to chest by a severe blow.        

Any infection to the lung or injury can lead to this condition, as it initiates the inflammatory processes. Inflammation of lung is caused by the inflammatory mediators like cytokines. If the injurious agent that causes the inflammation is not removed, then ARDS wil be converted into more severe condition called as severe respiraory inflammatory response. Long term illness eg malaria can also trigger it.                            


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Signs & Symptoms

ARDS occur within the 24-48 hours of an injury or attack of acute illness. Sign include respiratory acidosis. Patients show these signs:

  • Shortness of breath
  • Tachypnoea
  • Low blood pressure
  • Confusion
  • Extreme tiredness
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Prevention

No measures to prevent ARDS are presently known.


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Treatments
Mechanical Ventilation Modern Medicine

Patients with ARDS are treated in ICU or intensive care unit. The purpose of the treatment lies in the fact that patient gets proper oxygen, reducing further inflammation.

Oxygen is used to treat hypoxia. Patient is treated with higher concentrations of oxygen (100% oxygen concentration may be needed) so that blood level rises to give enough supply to the organs. Ventilator is a breathing machine use to ventilate the patients having lack of oxygen supply o the organs. Ventillation is done by endotracheal intubation which is carried out through a pipe inserted in the trachea. This treatment is continued until gradual weaning from the mechanism is tolerated.

Medicines Modern Medicine

Medications may be indicated to treat infections, reduce inflammation, and eliminate fluid within the lungs.The stress of illness can often be helped by joining support groups where members share common experiences and problems. Antibiotics are also given:

  • Pain killers i.e NSAIDS include aspirin
  • Muscle relaxants to prevent movements and to reduce the oxygen demand
  • Anti anxiety drug to keep the patient calm.
  • Corticosterois like methyl prednisolone to prevent the inflammatory condition
  • Nitric oxide, as it is a pulmonary vasodilator.
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