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The 5 signs of Acute Respiratory Distress Syndrome

Introduction

Most of us know how the respiratory system functions. Air that we inhale moves through the wind-pipe or trachea to reach both the lungs. The lungs are made up of lobes filled with air-sacs or alveoli. Thousands of alveoli inside the lungs facilitate gas exchange. That is, oxygen from the inhaled air is absorbed by the blood-vessels in these alveoli, and this oxygenated blood is transported to the heart and thereafter to rest of the body. Carbon-di-oxide from previously inhaled and processed air is expelled from the alveoli, out of the lungs and out of the body, through exhalation.

Needless to say, the lungs are ‘dry chambers’ and must be kept dry always, for proper functioning. Else, it can be dangerous to the person. Solids and fluids that enter the lungs accidentally, if not removed quickly, can cause temporary, or long-term damage. ARDS is a condition which happens exactly this way. (Incidentally, toxic gases that are inhaled also cause damage, but they cannot be removed).

Also Read: Complications arising out of Respiratory Disease

What is ARDS?

Acute Respiratory Distress Syndrome is a condition in which fluid (blood) starts filling up in the lungs. This happens when blood flowing in tiny capillaries in the lungs develop a leak. Normally, there is a thin membrane that encloses the capillaries. However, injuries and various conditions can cause the membrane to rupture, and the blood from capillaries to leak into the open space in the lungs (between the capillaries and alveoli). This increases the pressure in the lungs as some of the air is replaced by fluid now.

Gradually, the fluid enters the alveoli. This means the alveoli are no longer able to fully hold air, as they are now partly filled with fluid. This in turn means, gas exchange cannot happen properly. As a result, there is less oxygen being sent out from the blood in the lungs, to the rest of the body. The condition is called hypoxia (‘less oxygen’) which has life-threatening consequences. The different organs and parts of the body are no longer getting enough oxygen now which leads to damage and death to those tissues.

Causes and Risk Factors

Sepsis: This is a widespread infection of the bloodstream which can be quite serious. It is the most common cause of ARDS. A person admitted in the hospital for sepsis treatment is at a high probability of developing ARDS.
Inhaling harmful substances: Inhaling fumes containing toxic chemicals (as in industrial workers or severe air pollution from vehicle exhaust), breathing smoke from burning material, and long-term cigarette smoking are all risk-factors for ARDS.
Aspiration pneumonia: When one inhales their vomit, or a lot of water from near-drowning episodes, they are at severe risk of ARDS.
Severe pneumonia: Severe cases of pneumonia can affect all the lobes of the lungs and eventually trigger ARDS.
So also, patients of Chronic lung disease are at high risk of developing ARDS.
Major trauma or burns: Accidents (like vehicle crashes), falls from heights and collisions (as in contact sports) may directly damage the head, chest, lungs or parts of the brain that control breathing. This triggers severe inflammation in the lungs, and eventually ARDS.
Coronavirus disease 2019 (COVID-19): People who suffer from severe COVID-19 are at risk of developing ARDS.
Pancreatitis: This is an inflammation of the pancreas which eventually triggers ARDS.
Massive blood transfusions: Accident victims and patients who require a lot of blood (receiving over 15 units of blood in a short period of time) are at high risk of ARDS.
Drug overdose: Excessive use of drugs such as cocaine, opioids (sedatives) and tricyclic antidepressants increases risk.
Alcoholism: People with a history of chronic alcoholism are at high risk of developing ARDS and dying from the same.
Age: Being over 65 years of age
Taking supplementary oxygen for some lung condition
A recent high-risk surgery, or recent chemotherapy sessions
Obesity
Genetic factors: unknown gene mutations that cause such conditions

Also Read: Severe Asthma – Types and Treatments

5 Signs and Symptoms

Breathing related

Severe shortness of breath
Laboured (heavy) and unusually rapid breathing
Chest pain, especially when breathing deeply

Circulation related

Rapid heart rate

Metabolism related

Low blood pressure
Muscle fatigue and general weakness

Visible signs

Bluish colour of fingernails, skin and lips due to low oxygen levels in blood

Others

Confusion and extreme tiredness
Dry, hacking cough
Fever
Headaches
Dizziness

Complications from ARDS

Blood clots: Hospitalization can cause long hours of lying down while being hooked to a ventilator which increases the risk of blood-clots in deep veins of the legs. Some of these clots can break off and move to the lungs where they block blood-flow, thereby worsening the symptoms of ARDS.
Collapsed lung or pneumothorax: ARDS will require the use of ventilator to increase oxygen levels in the body and also force fluid out of the lungs. However, the high-air pressure from the ventilator can cause a small hole to develop on the outside of the lung. Air inside the affected lung starts leaking out of this hole, and eventually that lung collapses.
Infections: The ventilator is attached directly to a tube that goes into the trachea. This being a foreign body increases the risk of infections from germs, and hence further injury to the lungs.
Scarring or pulmonary fibrosis: Within a few weeks of ARDS developing, the tissue between the alveoli develops scarring and becomes thick. This makes the lungs stiff and inelastic. They can’t move smoothly like before, which makes it difficult for the oxygenated blood to flow from the alveoli into the bloodstream.
Breathing trouble: Most people with ARDS are able to breathe normally within 6 months to 2 years’ time. Some will require supplemental oxygen to be given at home for a few months. While the remaining small percentage of patients may suffer from shortness-of-breath and fatigue, for the rest of their lives.
Depression: Most ARDS patients suffer from depression both during and after treatment. However, this is not serious and is easily treatable.
Cognitive issues: The low oxygen levels caused by ARDS and the sedatives used during treatment can cause memory loss and problems with clear thinking. This is a temporary situation with most of the patients. But in a small number of people, the damage is permanent. They will have to constantly work on their mind (problem solving puzzles, and staying mentally active) to overcome the situation.
Muscle and overall fatigue: Lying on a hospital hooked to a ventilator for so long can cause atrophy of the muscles. They begin to weaken, so the person feels constantly tired after treatment. The person has to begin an exercise program to strengthen the muscles again.

Also Read: The difference between Bronchitis and Pneumonia

Diagnosis

Imaging tests such as chest X-ray and CT-scan
Blood tests that look for signs of infection or anaemia, and measure oxygen levels in the blood
Heart tests such as Electrocardiogram and Echocardiogram
Pulse oximetry (a fingertip sensor) to constantly monitor oxygen levels
Taking a sample of secretions from the patient’s airways (through throat and nose swabs) to find the cause of infection
Physical examination of the airways

Treatment

Supplemental oxygen for people with milder symptoms
Mechanical ventilation to help the person breathe better (by forcing oxygen from air into lungs and forcing the fluid out of the air-sacs)
IV Fluids that are carefully dispensed, to provide nutrition and medication
Medication that helps to minimize fluid build-up in the lungs, to treat infection, prevent blood-clots in the legs and lungs, to sedate the person, to relieve pain and discomfort and to minimize or prevent gastric reflux.
Diuretics to remove extra fluid in body due to ARDS
Lifestyle changes: quitting smoking, minimizing alcohol consumption and taking regular vaccine shots for flu and pneumonia
Physical therapy to recover muscle strength
Pulmonary rehabilitation to strengthen the lungs and improve breathing by increasing lung capacity

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801