Acute Respiratory Distress Syndrome

Subin

Nursing Supervisor, Kauvery Hospital, Hosur, India

Introduction

Acute Respiratory Distress Syndrome (ARDS) is a serious lung condition that causes fluid to build up in the lungs, making it difficult to breath and reducing the amount of oxygen in the blood.

ARDS occurs when lung swelling causes fluid to build up in the tiny elastic air sacs in the lungs. These air sacs, called alveoli, have a protective membrane, but lung swelling damages that membrane. The fluid leaking into the air sacs keeps the lungs from filling with enough air. This means less oxygen reaches the bloodstream, so the body’s organs don’t get the oxygen they need to work properly.

The most common precipitating factor is pneumonia (66 %). Children with pneumonia have been reported to develop moderate ARDS (35.9%) . Overall mortality can be 33%, with more than half belonging to severe ARDS group (58%). ARDS patients develop symptoms, usually severe shortness of breath – within a few hours to a few days after the injury or infection.

Many people who get ARDS don’t survive. The risk of death gets higher with age and how severe the illness is. Of the people who survive ARDS, some fully recover. But others have lasting lung damage. We are following proper SOP for those who came for acute respiratory syndrome. Through that we achieved successful discharge of most of the patients and good feedback.

Case Presentation

Patient Information

Age: 37yr
Sex: Female
Past medical history: Nil
Past surgical history: Nil

Patient’s presentation

She had fever and dry cough for 2 days which she had taken treatment initially in outside hospital, but there was no improvement

She was brought to our Emergency

On arrival patient was conscious and oriented; her oxygen level was low on room air- 52 to 57 %, and respiratory rate was 50 per minute.

On auscultation bilateral basal crepitations were present. Apache II score 18 which indicated 25% risk of mortality. Doctors team commenced Bipap support. Even with high PEEP 12 and PS 22, Fio2 100%t her condition did not improve. Meanwhile we had put her on knee chest position but bbreathing did not improve. After taking high risk consent, she was intubated with the settings of Pressure control mode VT 500, PEEP 10, Pressure Support – 20, Fio2 100, RR – 14. Then we provided prone ventilation after all safety precautions.

After 2 days, her ABG improved and ventilator setting was changed to VT 500, Peep 8, Ps 15, fio2 50%; on the subsequent days, we changed mode to CPAP and weaned from ventilator. We started agaggressive chest vibration every 4th hourly and limb exercises. We avoided any hospital acquired infection.

Her CT chest shows bilateral diffuse area of consolidation. Pulmonologist opinion was obtained, ABG was taken twice in a day and ventilator settings adjusted as per ABG. Her X-ray reports showed satisfactory improvement after proper chest physio and nebulization.

Patient was extubated on 5th day of admission. On 6th day patient was shifted to ward with oxygen support, Our ICU team made regular visits on in each shift and reported to HOD daily. Patient was discharged to home with stable condition on 8th day.

X-ray Images

Diagnostic test

On admission

Investigations	Result
TC	15080
Platelet count	50000/cumin
Sodium	137mmol/l
Potassium	3.3
PH	7.35
PCO2	29.5
PO2	47
SO2	87
LAC	2.27

PF Ratio: 47.0 mmHg; Mortality can be severe >45%.

The partial pressure of oxygen in arterial blood (PaO2) to the fraction of inspired oxygen (FiO2) ratio, also known as the P/F ratio, is a measure of how well oxygen is being transported in the blood. It’s used to assess the severity of respiratory distress syndrome (ARDS) and to monitor oxygenation in critically ill patients.

H1N1 & Covid: Negative

Before Extubation

Investigations	Result
PH	7.34
PCO2	46
PO2	189
HCO3	26.8
LAC	1.4
TC	10020
Platelet	134000
Potassium	4.2

Post Extubation

Investigations	Result
PH	7.48
PCO2	36
PO2	91
HCO3	28
LAC	1.4
SO2	98

Nursing Management

Fluid Management: Educated about the role of fluid management in reducing the risk of fluid overload, which can worsen ARDS in that we are focussing of invisible fluid loss and each shift fluid balance so that achieved good hydration. 2.4 litre per day was followed.

Physical Therapy: We have taken physiotherapist support for giving every 4th hourly chest vibration and limb physio therapy, they were also daily monitoring of ABG and X-Ray. Active implementation of multidisciplinary therapy, day by day improvement was seen, patient and relatives was satisfactory.

Long-Term Monitoring: Advised the patient and family that ARDS recovery can be slow and that regular follow-up appointments will be necessary to monitor lung function and overall health.

Anxiety and Stress: Patient may feel anxious or confused due to their condition. Encouraged relaxation techniques like listening music and allowing attenders to talk with her.

Family Support: Explained to the family members’ importance of family support, including emotional support, keeping them informed about progress, and being involved in care. Video counselling done. Along with treatment family support is essential for all patients those who are sick or required treatment.

Healthy Habits: Explained to the patient to take care of lungs by avoiding smoking or other hand smoking, maintaining a healthy weight, and staying active. Life style diseases to be maintain under control.

Vaccinations: Explained to the patient about importance of vaccinations, like flu vaccine and pneumonia vaccine, can help prevent infections that could affect your lungs and reduce the risk of another episode of ARDS.”

Nutritional support: High protein diet provided. Diet chart planned with the help of dietitian.

Condition on discharge

Patient was ambulatory without any support. Multidisciplinary team work gave a best result.

Learning Points regarding ARDS

Early recognition and management of ARDS are important to improve outcomes
Mechanical ventilation and peep filtration are important in treating ARDS
Fluid management and broad- spectrum antibiotics are also crucial in managing ARDS
Prevention of Complications like VAP, AKI, and sepsis gives a faster recovery.
Multidisciplinary team involvement shows a strength of unity towards quality care that contributes our core value of CHEERS.

Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome

Subin

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