ARDS

Acute respiratory distress syndrome (ARDS) is an acute and persistent lung disease characterized by an arterial hypoxemia (PaO2/FiO2<200 mmHg), resistant to oxygen therapy and bilateral infiltrates on chest X ray’ (Lucangelo et al).  Brunner and Suddarth defined ARDS is a clinical syndrome characterized by a sudden and progressive pulmonary edema, increasing bilateral infiltrates on chest x-ray, hypoxemia refractory to oxygen supplementation, and reduced lung compliance. These signs occur in the absence of left-sided heart failure. Patients with ARDS usually require mechanical ventilation with a higher than normal airway pressure.

Pathophysiology For ARDS

Inflammatory damage to the alveoli, either by locally produced Pro- inflammatory mediators, or remotely produced and arriving via the pulmonary artery. The change in pulmonary capillary permeability allows fluid and protein leakage into the alveolar spaces with pulmonary infiltrates. The alveolar surfactant is diluted with loss of its stabilizing effect, resulting in diffuse alveolar collapse and stiff lungs.

Causes For ARDS

There are many causes of pro-inflammatory mediator release sufficient to cause ARDS, and there may be more than one present. Common causes in order of prevalence:

• Sepsis/pneumonia; secondary risk factors for developing ARDS, when septic, are alcoholism and cigarette smoking
• Gastric aspiration (even if on a proton pump inhibitor, indicating that a low pH is not the only damaging component)
• Trauma/burns, via sepsis, lung trauma, smoke inhalation, fat emboli, and possibly direct effects of large amounts of necrotic tissue.

Nursing Assessment Nursing Care Plans for Acute Respiratory Distress Syndrome (ARDS)

ARDS showed that, in patients with ALI (acute lung injury), elevated levels of PAI-1 (plasminogen activator inhibitor-1)  in pulmonary oedema fluid and in plasma are associated with a higher mortality rate and fewer days of assisted ventilation. Recently, Ware LB et al. showed that protein C levels were lower in ALI/ARDS patients than in normal subjects and were associated with worse clinical outcomes, including death, fewer ventilator-free days, and more non-pulmonary organ failures, even when only those patients without sepsis were analyzed. Levels of thrombomodulin in the pulmonary edema fluid of patients with ALI/ARDS were more than ten-fold higher than in normal plasma and two-fold higher than in ALI/ARDS plasma. Higher thrombomodulin levels in edema fluid were associated with worse clinical outcomes. Decreasing circulating protein C and increased circulating thrombomodulin are markers of the pro-thrombotic, anti fibrinolytic state. Intercostal retractions and crackles, as the fluid begins to leak into the alveolar interstitial space, are evident on physical examination.

A diagnosis of ARDS may be made based on the following criteria: a history of systemic or pulmonary risk factors, acute onset of respiratory distress, bilateral pulmonary infiltrates, clinical absence of left-sided heart failure, and a ratio of partial pressure of oxygen of arterial blood to fraction of inspired oxygen (PaO2/FiO2) less than 200 mm Hg (severe refractory hypoxemia)

Nursing diagnosis Nursing Care Plans for Acute Respiratory Distress Syndrome (ARDS)

Common nursing diagnosis found inNursing Care Plans for Acute Respiratory Distress Syndrome (ARDS)

• Ineffective airway clearance
• Ineffective breathing pattern
• Activity intolerance
• Anxiety (specify level: mild, moderate, severe, panic)
• Disturbed gas exchange
• Risk for aspiration

Nursing interventions Nursing Care Plans for Acute Respiratory Distress Syndrome (ARDS)