Acute Respiratory Distress Syndrome
What is Acute Respiratory Distress Syndrome?Acute respiratory distress syndrome is understood by physicians to be an acute lung injury of the patient.
This so-called shock lung is caused by inflammation of the lung tissue, which can be caused by different actions. The result of not timely treatment can be: shock, unconsciousness to organ failure and heart failure.
Acute Respiratory Distress Syndrome refers to the strong response of the lungs to various damaging factors. The disease Acute Respiratory Distress Syndrome is characterized by multifactorial damage to the lungs with formation of pulmonary edema and consecutive oxygenation disorder.
Acute respiratory failure, known as shock lung, describes a sudden respiratory distress caused by lung injury. The affected person gets very bad air, whereby the carbon dioxide content in the blood increases and the oxygen content decreases. Possible consequences of non-timely treatment include: unconsciousness, states of shock, organ failure and heart failure.
The cause of Acute Respiratory Distress Syndrome lies in inflammation of the lung tissue, which can be caused by different actions. The pre-existing conditions may be quite different, such as pneumonia, injuries, poisoning. The main causes include the inhalation of harmful substances, such as smoke or the aspiration of various substances, such as gastric fluid.
Indirect effects such as coagulation disorders or injuries can lead to Acute Respiratory Distress Syndrome. This results in a pulmonary edema, because inside the alveoli increases the permeability of the blood vessels. This leads to a pressure drop in some vascular areas of the lung tissue. At the same time, there is a duck increase in other parts. In addition, proteins escape, whereby the oxygen supply of the blood decreases considerably and the carbon dioxide content increases.
Symptoms, complaints & signs
Acute Respiratory Distress Syndrome develops in most cases about 24 to 48 hours after the original injury or illness occurred. The sufferer first experiences a shortness of breath, which is usually accompanied by a fast, shallow breathing. The doctor can hear a crackling or wheezing in the lungs with a stethoscope.
Due to the low oxygen content in the blood, the skin may be patchy or blue (cyanosis). Other organs, such as the heart and brain, may experience malfunction such as rapid heart rate, cardiac arrhythmia, confusion, and lethargy.
Diagnosis & History
Acute Respiratory Distress Syndrome, the most common cause of acute lung injury, usually starts with the following symptoms: Due to the damage to the lung tissue, the patient initially feels that breathing is difficult. He begins to breathe faster, so that he can counter this. This leads to hyperventilation.
The lips and fingernails may turn blue after some time. Physicians distinguish between three phases:
- In the first phase, due to damage to the tissue, the biochemical process takes place.
- In the second phase the symptoms increase. As a result, in the third phase, the person concerned only has one lung volume that corresponds to an infant.
Inflammation has stopped most of the lung tissue from functioning. Depending on the extent, the low oxygen content can have various consequences, ranging from unconsciousness, shock to organ failure, to heart failure. The doctor usually diagnoses ARDS for the pre-existing condition.
When listening to the lungs, the first signs appear, because here a rattle noise is perceived. A subsequent X-ray examination can provide a more accurate diagnosis. This shows in the alveoli possible storage, which can be a clear indication of an incipient shock lung.
Acute Respiratory Distress Syndrome, often referred to as shock lung, is associated with an extreme inflammatory response of the lungs and lung tissue. This causes a pathological reaction chain that leads to a number of complications.
First, pulmonary edema often develops due to inflammatory lung damage. The reason is the increase in the permeability (permeability) of the capillaries. This inflammatory reaction also leads to the immigration of certain white blood cells, which release lytic enzymes and oxygen radicals, thus enhancing the original inflammation.
If the patient is not treated or not successfully treated, these inflammatory mediators in the next stage, which further increases the permeability of the capillaries. This often results in an alveolar edema, ie an alveolar blister. In the next stage, the surfactant, a kind of protective substance on the alveoli, is destroyed.
This leads to further serious complications. As a rule, an atelectasis, ie a ventilation deficit of the lung or of individual parts of the lung, is the consequence. As a result, the oxygenation of the blood and thus the oxygenation of the brain and other organs is extremely deteriorated.
At this stage, the Atemnotsydrom runs mostly deadly. If the patient survives, there are usually further complications during the healing process. Frequently, the body can only replace the destroyed lung tissue with connective tissue. The oxygen supply of the body is thereby permanently reduced.
When should you go to the doctor?
An acute "respiratory distress" syndrome, ie acute respiratory distress due to an onset of respiratory failure, requires an immediate visit to the doctor or immediate call of the emergency physician. It is a relatively sudden onset of respiratory failure that needs immediate attention. The so-called shock lung can lead untreated within a short time to death.
The Acute Respiratory Distress Syndrome is a dramatic emergency situation. The affected person will probably quickly become unconscious due to the sudden respiratory distress. Without medical help, the patient will not survive this emergency.
On the one hand, the affected person must be immediately ventilated, so that the carbon dioxide content in the blood drops. On the other hand, the cause of the Acute Respiratory Distress Syndrome must be determined as quickly as possible. This can best be done in a clinic where the sufferer is given all the medical help he needs.
Possibly, the attending physician is aware of pre-existing conditions that may be the trigger. Otherwise, the testimony of those present who are aware of what happened 24 to 48 hours before the onset of respiratory distress and respiratory failure is important to the patient. Quick action is particularly important in the Acute Respiratory Distress Syndrome, so as not to damage the failing lung worse. It is expected that there will be complications with delays.
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Treatment & Therapy
The treatment of Acute Respiratory Distress Syndrome is intensively medically. Within a few hours, the disease can lead to respiratory decompensation with a need for ventilation. The decompensation occurs when a body can no longer compensate for the defects caused by a disease. In the first place, it is important to treat the triggering cause and to use mechanical ventilation at an early stage.
During ventilation of the patient, often only a small pressure amplitude is available in order to shift the tidal volume. As a result, hypercapnia can occur. In individual cases, this must be tolerated. Patients with increased intracranial pressure, however, represent an absolute contraindication. Therapeutic options to avoid hypercapnia include high-frequency oscillation and extracorporeal lung support with a heart-lung machine.
Due to the increased risk of thrombosis in immobilization, a low-dose heparinization should be accompanied. If possible, the patient is fed enterally via a central venous catheter or a gastric tube. Often both diets have to be used. The therapy requires intensive medical effort. Late in the course of healing by the administration of glucocorticoids, pulmonary fibrosis can be reduced.
Outlook & Forecast
The Acute Respiratory Distress Syndrome is a very serious and dangerous condition for the patient and usually leads to death without treatment. It comes to severe breathing difficulties, which are often accompanied by a panic attack. Furthermore, it can lead to a direct lung failure without treatment. As a result, organs are not supplied with enough oxygen and can be damaged. In the worst case, it comes to cardiac arrest. In most patients, Acute Respiratory Distress Syndrome also causes hyperventilation and loss of consciousness.
The further course of the disease depends very much on the cause of the Acute Respiratory Distress Syndrome and its treatment. An acute treatment by the ambulance can relieve most discomfort and save the patient. Without treatment, the patient dies after a few minutes. If the supply of air has been interrupted for a few minutes, then various damage to the organs may have developed. In some cases, this leads to paralysis or spasticity.
The optimal way to prevent the disease Acute Respiratory Distress Syndrome is to treat the underlying disease, which can lead to acute respiratory failure, intensively. This is absolutely necessary so that it does not lead to the disturbance of breathing. Nevertheless, if a lung failure occurs, it is important that this is detected in time to prevent serious consequences.
Therefore, it is very important that the doctor considers a shock lung already at the first signs of respiratory distress, for which there is no explanation. The shock lung is an acute, life-threatening damage to the lungs. Therefore, for unusual symptoms should always be consulted a physician who determines the causes of the symptoms.
Acute lung failure is always a life-threatening disease. Patients with Acute Respiratory Distress Syndrome rarely experience medical follow-up because of the drama of the event. A high number of those affected die as a result of multiple organ failure. Often there is a systemic inflammatory process - a Systemic Inflammatory Response Syndrome or SIRS - present at the same time.
The Acute Respiratory Distress Syndrome may be present in three severity levels. These are treated with different intensity. The causes of ALRS are numerous. Correspondingly, in mild Acute Respiratory Distress Syndromes, other follow-up measures may be needed than with a moderately severe one. In severe cases with advanced sepsis, severe burn injuries, or traumatic brain injury, death is almost always inevitable.
In part, an already advanced Acute Respiratory Distress Syndrome can be survived by self-healing mechanisms of the organism. However, in spite of all intensive care interventions, survivors usually suffer from severe lung damage. These require permanent follow-up care. Patients are often dependent on the ventilator after the survival of the Acute Respiratory Distress Syndrome. They are much more susceptible to pneumonia, pulmonary fibrosis or blood poisoning.
The mortality rate is between 55 and 70 percent. Permanent bedridden ARDS patients are poorly protected from developing thrombosis and embolism. Aftercare must take into account the high degree of endangerment of those affected.
You can do that yourself
Persons suffering from an acute respiratory distress syndrome must be treated promptly by an emergency physician. Until the arrival of the rescue service, the person affected must be placed in the prone position and calmed down. In the event of respiratory or cardiac arrest, resuscitation measures should be taken, such as mouth-to-mouth resuscitation or the use of a defibrillator.
The Acute Respiratory Distress Syndrome is a serious syndrome that always requires medical attention. The person concerned must spend some time in the hospital after the emergency. In the case of a positive course, a few days to weeks after the procedure can be started again with light physical activity. Accompanying this, it is important to identify and remedy the causes of the medical emergency.
Since acute respiratory distress syndrome is always the consequence of a protracted illness or of a serious accident, treatment focuses on symptomatic therapy, as causal treatment is generally no longer possible. The curative or palliative medical measures can be supported by general measures such as physiotherapy, a diet and discussions with a suitable therapist.