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Potentially life-threatening emergency
Acute respiratory distress syndrome
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Potentially life-threatening emergency

Acute respiratory distress syndrome

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Contributors: Karna Sarin MD, Ryan R. Walsh MD, Joshua J. Jarvis MD, Alastair Moore MD, Paritosh Prasad MD
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Synopsis

Acute respiratory distress syndrome : Cyanosis, Hypoxemia, Dyspnea, HR increased, Bibasilar crackles
Acute respiratory distress syndrome, commonly known as ARDS, is a life-threatening inflammatory condition of the lungs. It presents with the hallmark findings of acute hypoxic respiratory failure, including dyspnea, tachypnea, tachycardia, confusion, diaphoresis, and cyanosis as well as lung crackles, and a chest radiograph showing bilateral patchy pulmonary infiltrates that are not due to a cardiac cause or volume overload. It is usually seen after exposure to a clinical stressor or within 1 week of such a stressor.

Clinically, ARDS is characterized by decreased compliance in the lungs ("stiff lungs"). On a microscopic level, it involves alveolar edema due to increased permeability from membrane destruction ("leaky capillaries") as well as neutrophil infiltration, which can lead to activation of a localized inflammatory response. Once the alveoli are damaged, they will start to collapse, leading to atelectasis derecruitment of the lung. Although mechanical ventilation is the mainstay of treatment, it can be challenging and must be done carefully and within specific parameters, as repetitive re-expansion and collapse of the alveoli can lead to mechanical injury known as atelectrauma and the elevated mean airway pressures or excess tidal volumes in the setting of decreased lung compliance result in alveolar barotrauma / volutrauma.

The Berlin Definition of ARDS was published in 2012, identifying specific criteria for diagnosis.

Related topics: respiratory distress syndrome in the newborn, respiratory failure

Codes

ICD10CM:
J80 – Acute respiratory distress syndrome

SNOMEDCT:
373895009 – Acute respiratory distress

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Pulmonary edema from heart failure – Can be diagnosed by left atrial hypertension and changes on an echocardiogram.
  • Chronic interstitial lung disease – Usually will not be as acute in presentation, but will have a more gradual, indolent course and prior radiographic findings.
  • Hypersensitivity pneumonitis – Will be in the clinical context of a recent inhalation; although not as severe, it can progress to ARDS.
  • Diffuse alveolar hemorrhage – Bronchoscopy will show progressively more blood-tinged lavage samples.
  • Acute interstitial pneumonia – Will resemble ARDS both radiographically and clinically, but without an obvious cause or stressor. Histopathology will show diffuse alveolar damage on lung biopsy. Some patients will benefit from steroids. This should be considered when ARDS does not improve despite aggressive treatment.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:03/21/2023
Last Updated:03/22/2023
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Potentially life-threatening emergency
Acute respiratory distress syndrome
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A medical illustration showing key findings of Acute respiratory distress syndrome : Cyanosis, Hypoxemia, Dyspnea, HR increased, Bibasilar crackles
Imaging Studies image of Acute respiratory distress syndrome - imageId=8346315. Click to open in gallery. caption: '<span>Single portable recumbent AP view of the chest. A second radiograph obtained 8 hours after initial radiograph demonstrates diffuse, bilateral airspace opacities, left greater than right (straight black arrows). In the left hemithorax, where fewer airspace opacities obscure the periphery of the lung, there is no convincing evidence of Kerley B lines or pleural thickening (as one might see in hydrostatic pulmonary edema).</span>'
Single portable recumbent AP view of the chest. A second radiograph obtained 8 hours after initial radiograph demonstrates diffuse, bilateral airspace opacities, left greater than right (straight black arrows). In the left hemithorax, where fewer airspace opacities obscure the periphery of the lung, there is no convincing evidence of Kerley B lines or pleural thickening (as one might see in hydrostatic pulmonary edema).

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