Acute Respiratory Distress Syndrome (ARDS)

Etiology and Pathophysiology
■ Direct or indirect lung trauma → inflammation → fluid movement into
alveolar spaces and ↓surfactant → atelectasis → hypoxia and ↑dead space
■ Secondary to trauma, aspiration, shock, infection

Signs and Symptoms
■ Early: Dyspnea, anxiety, ↓O2 sat, ↓PaO2
■ Late: ↑CO2, cyanosis, lung infiltrate on x-ray

Treatment
■ Treat cause; mechanical ventilation and positive end expiratory pressure
(PEEP—keeps alveoli open)
■ Steroids, interleukin-1 receptor antagonists, surfactant therapy
■ Sedatives or neuromuscular

Nursing Management
■ Monitor S&S; suction airway
■ Mechanical ventilator care:
■ Assess breath sounds for equality (PEEP → ↑risk of pneumothorax,
ET tube may be in right bronchi)
■ Maintain trach or endotracheal tube cuff pressure seal to ensure full
volume delivery
■ Check ventilator settings and alarms (↑pressure secondary to mucus or
tubing kinks and ↓pressure secondary to ↓cuff pressure or separation
of tubing)
■ Provide alternate mode of communication