Overview
Acute Respiratory Distress Syndrome (ARDS) is a life-threatening lung condition that occurs when fluid builds up in the tiny air sacs (alveoli) of the lungs, preventing oxygen from reaching the bloodstream. ARDS develops rapidly and usually requires emergency medical care and mechanical ventilation. It commonly occurs in critically ill patients and has a high mortality rate without prompt intervention.
What is Acute Respiratory Distress Syndrome (ARDS)?
ARDS is a severe form of respiratory failure that results from inflammation and fluid accumulation in the lungs. It is not a disease in itself but a complication of various critical illnesses or injuries, such as pneumonia, sepsis, or trauma. The fluid in the lungs reduces oxygen exchange, leading to dangerously low oxygen levels throughout the body.
Symptoms
Symptoms of ARDS typically appear within hours to a few days after the triggering event and may include:
- Severe shortness of breath
- Rapid, shallow breathing
- Labored breathing or use of accessory muscles
- Hypoxemia (low blood oxygen)
- Cough (often dry or with frothy sputum)
- Cyanosis (bluish lips or fingertips)
- Confusion, fatigue, or extreme drowsiness
- Low blood pressure
Causes
ARDS can be triggered by a wide range of direct and indirect lung injuries, including:
Direct Lung Injury:
- Pneumonia
- Aspiration of stomach contents
- Inhalation of toxic fumes or smoke
- Pulmonary contusion (chest trauma)
Indirect Lung Injury:
- Sepsis (widespread infection)
- Severe trauma or burns
- Pancreatitis
- Transfusion-related lung injury
- Drug overdose
- Near-drowning
Risk Factors
The following factors increase the risk of developing ARDS:
- Sepsis (most common cause)
- Older age
- Smoking history
- Chronic lung diseases (e.g., COPD)
- Alcohol abuse
- Multiple blood transfusions
- Major surgery or trauma
- Genetic predispositions
Complications
ARDS can cause several serious, long-term complications, even in survivors:
- Lung scarring and reduced lung function
- Cognitive impairment (due to oxygen deprivation)
- Muscle weakness and fatigue
- Psychological effects (PTSD, depression)
- Long-term need for oxygen or breathing support
- Organ failure (especially kidneys and heart)
- Increased mortality risk
Prevention
While ARDS itself may not always be preventable, reducing the risk involves:
- Preventing and treating infections promptly, especially sepsis and pneumonia
- Using lung-protective ventilation in at-risk patients
- Avoiding aspiration in hospitalized or unconscious patients
- Avoiding unnecessary blood transfusions
- Quitting smoking and avoiding air pollutants
- Managing chronic health conditions effectively
Treatment Options Korea
1. Intensive Care Unit (ICU Admission)
- All moderate to severe ARDS patients require ICU-level care
- Managed by critical care specialists, pulmonologists, or anesthesiologists
- Close monitoring of:
- Oxygenation (PaO₂/FiO₂ ratio)
- Hemodynamics
- Fluid balance
2. Mechanical Ventilation
- Lung-protective ventilation strategy using:
- Low tidal volume (6 mL/kg)
- High PEEP to prevent alveolar collapse
- Sedation and paralysis may be used in severe cases
- Prone positioning (face-down) improves oxygenation in severe ARDS
3. Oxygen Therapy
- For mild cases, high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV) may be used initially
- Invasive ventilation if hypoxemia worsens or work of breathing increases
- ARDS care is widely available in Korean tertiary hospitals and ICUs
4. Treatment of Underlying Cause
- Common triggers include:
- Sepsis, pneumonia, aspiration, trauma, or COVID-19
- Prompt use of antibiotics, antivirals, or surgical management if needed
- Source control (e.g., drainage of abscess or infected fluid) is crucial
5. Fluid Management
- Conservative fluid strategy after initial resuscitation to avoid pulmonary edema
- Use of diuretics (e.g., furosemide) may be considered when stable
6. Rescue Therapies (If Refractory)
- Extracorporeal Membrane Oxygenation (ECMO):
- Used in severe, unresponsive ARDS
- Available in specialized centers like Samsung Medical Center, Asan Medical Center, National Medical Center
- Inhaled nitric oxide, steroids, or recruitment maneuvers may be tried case-by-case
7. Nutritional and Supportive Care
- Enteral feeding started early
- Glycemic control, prevention of DVT, stress ulcers, and ICU-acquired infections
- Rehabilitation and physical therapy once stable
8. Long-Term Follow-Up
- Survivors may have lung fibrosis, PTSD, depression, or physical weakness
- Pulmonary rehab, mental health support, and post-ICU care programs available in Korean university hospitals
