Acute Respiratory Distress Syndrome (ARDS)

Acute Respiratory Distress Syndrome (ARDS):

  • ARDS is a severe manifestation of acute lung injury: acute and persistent lung inflammation with increased vascular permeability.
  • Common in ICU patients (10-15%), especially intubated patients (20%)
  • Causes:
    • ***Sepsis: most common cause of ARDS***
    • Aspiration of gastric contents
    • Infectious pneumonia
    • Severe trauma or surface burns
    • Massive blood transfusion
    • Drug overdose: Aspirin, Cocaine, Opioids, Phenothiazines, TCAs
  • Dx:
    • Bilateral pulmonary infiltrates (on radiograph)
    • PaO2/FIO2 <200 mmHg
    • BNP <200 (rules out CHF – no cardiogenic pulmonary edema)
      • No clinical evidence of elevated left atrial pressure. If measured, PCWP < 18 mmHg.


  • Ventilatory strategies:
    • Using lower tidal volume (6ml/kg) = less lung damage
    • Using lower airway pressures (end-expiratory plateau pressure of < 30 cm H2O) have been associated with lower mortality from ARDS and have decreased the length of time required for mechanical ventilation.
    • Using higher PEEP = keep alveoli open
  • There is some evidence that corticosteroids (Methylprednisolone 1mg/kg/day continuous IV infusion) can reduce mortality and time on the ventilator.
  • Allow for “permissible hypercapnia” (elevated CO2 level is ok) – put patient in a deeper level of sedation so that the patient does not fight the ventilator.
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