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{{Acute respiratory distress syndrome}} | {{Acute respiratory distress syndrome}} | ||
{{CMG}} | {{CMG}}, {{AE}} {{BShaller}} | ||
==Overview== | ==Overview== | ||
ARDS usually | ARDS usually develops within 24 to 48 hours of the initial [[injury]] or [[illness]] and typically progresses over the course of 1 to 2 weeks (please refer to [[Acute respiratory distress syndrome pathophysiology|'''Pathophysiology of ARDS''']] for a discussion of this topic in greater detail). Failure to diagnose and treat ARDS early on is associated with a high [[mortality rate]] and may result in lifelong [[complications]] among survivors. | ||
==Natural History== | ==Natural History== | ||
The first signs of ARDS typically present within 24 to 48 hours of the precipitating [[illness]] or [[injury]] and progress over the course of 1 to 2 weeks. The early clinical features of ARDS include: | |||
*[[Hypoxemia]] (a declining peripheral blood oxygen saturation [SpO<sub>2</sub>] on [[pulse oximetry]] or a declining partial pressure of oxygen [PaO<sub>2</sub>] on [[arterial blood gas]] analysis) requiring high concentrations of supplemental oxygen (i.e., a higher [[fraction of inspired oxygen]] [FIO<sub>2</sub>]) or positive pressure ventilation (i.e., a higher [[continuous positive airway pressure]] [CPAP] or a higher [[positive end-expiratory pressure]] [PEEP]) in order to maintain acceptable blood oxygenation | |||
*[[Tachypnea]] and [[Dyspnea|labored breathing]] | |||
*[[Tachycardia]] | |||
*Signs or symptoms that suggest worsening of the underlying illness | |||
Left untreated, the [[mortality rate]] from ARDS is estimated to be upwards of 70%.<ref name="pmid11056707">{{cite journal| author=Reynolds HN, McCunn M, Borg U, Habashi N, Cottingham C, Bar-Lavi Y| title=Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base. | journal=Crit Care | year= 1998 | volume= 2 | issue= 1 | pages= 29-34 | pmid=11056707 | doi=10.1186/cc121 | pmc=28999 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11056707 }} </ref> | |||
==Complications== | |||
[[Complications|Long-term sequelae]] of ARDS are common, however, they are more likely to develop among those who do not receive early or adequate treatment. They include: | |||
*Significant [[weakness]] due to [[muscle atrophy|critical illness myoneuropathy and muscle atrophy]] as a result of long-term immobilization, sometimes resulting in lifelong physical disability | |||
*Impaired [[Spirometry|lung function]] | |||
*Chronic [[Mechanical ventilation|ventilator dependency]] due to advanced weakness and [[atrophy]] of the [[muscles of respiration]] | |||
*[[Fibrotic lung disease|Pulmonary fibrosis]] and [[restrictive lung disease]] | |||
*[[Psychiatric illness]] (e.g., [[post-traumatic stress disorder]] [PTSD], [[anxiety]], [[depression]]) | |||
*Impaired [[cognition]] | |||
*[[Persistent vegetative state]] or [[brain death]] due to prolonged hypoxemia | |||
The most common complications of ARDS are those associated with a prolonged [[ICU]] stay: | |||
*[[Nosocomial infection|Secondary or nosocomial infections]] (e.g., [[hospital-acquired pneumonia|ventilator-associated pneumonia]] [VAP] or [[Intravascular device related infections|central line-associated blood stream infection]] [CLABSI]) | |||
* | *[[Venous thromboembolism|Venous thromboembolic events]] (e.g., [[deep vein thrombosis]] [DVT] or [[pulmonary embolism]] [PE]) | ||
* | *[[GI bleed|Gastrointestinal bleeding]] (often secondary to [[Stress ulcer|stress ulcers]]) | ||
*[[Pressure ulcers]] and poor [[wound healing]] | |||
* | *[[Muscle atrophy|Muscle wasting]] and atrophy | ||
* | |||
* | |||
==Prognosis== | ==Prognosis== | ||
Prognosis for patients with ARDS varies based on the [[Acute respiratory distress syndrome diagnostic criteria|severity of illness]], the [[Acute respiratory distress syndrome causes|precipitating insult}}, and [[Acute respiratory distress syndrome risk actors|medical comorbidities]]: | |||
*The [[Acute respiratory distress syndrome historical perspective|ARDS Definition Task Force]] calculated 90-day morality rates for mild, moderate, and severe ARDS as 27%, 32%, and 45%, respectively<ref name="pmid22797452">{{cite journal| author=ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E et al.| title=Acute respiratory distress syndrome: the Berlin Definition. | journal=JAMA | year= 2012 | volume= 307 | issue= 23 | pages= 2526-33 | pmid=22797452 | doi=10.1001/jama.2012.5669 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22797452 }} </ref> | |||
*The 1-year mortality rate for patients with ARDS who survive to hospital discharge varies widely between different studies and is estimated to be anywhere from 11% to over 40%<ref name="pmid12594312">{{cite journal| author=Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F et al.| title=One-year outcomes in survivors of the acute respiratory distress syndrome. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 8 | pages= 683-93 | pmid=12594312 | doi=10.1056/NEJMoa022450 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12594312 }} </ref><ref name="pmid20384998">{{cite journal| author=Linko R, Suojaranta-Ylinen R, Karlsson S, Ruokonen E, Varpula T, Pettilä V et al.| title=One-year mortality, quality of life and predicted life-time cost-utility in critically ill patients with acute respiratory failure. | journal=Crit Care | year= 2010 | volume= 14 | issue= 2 | pages= R60 | pmid=20384998 | doi=10.1186/cc8957 | pmc=2887181 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20384998 }} </ref><ref name="pmid24435201">{{cite journal| author=Wang CY, Calfee CS, Paul DW, Janz DR, May AK, Zhuo H et al.| title=One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome. | journal=Intensive Care Med | year= 2014 | volume= 40 | issue= 3 | pages= 388-96 | pmid=24435201 | doi=10.1007/s00134-013-3186-3 | pmc=3943651 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24435201 }} </ref> | |||
*One study of patients diagnosed with ARDS in Maryland, United States, from 1992 through 1995 calculated an in-hospital mortality rate of 36% to 52%<ref name="pmid11056707">{{cite journal| author=Reynolds HN, McCunn M, Borg U, Habashi N, Cottingham C, Bar-Lavi Y| title=Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base. | journal=Crit Care | year= 1998 | volume= 2 | issue= 1 | pages= 29-34 | pmid=11056707 | doi=10.1186/cc121 | pmc=28999 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11056707 }} </ref> | |||
*The mortality rate among patients with ARDS due to [[trauma]] appears to be lower than among patients with ARDS due to [[sepsis]]<ref name="pmid20507948">{{cite journal| author=Sheu CC, Gong MN, Zhai R, Chen F, Bajwa EK, Clardy PF et al.| title=Clinical characteristics and outcomes of sepsis-related vs non-sepsis-related ARDS. | journal=Chest | year= 2010 | volume= 138 | issue= 3 | pages= 559-67 | pmid=20507948 | doi=10.1378/chest.09-2933 | pmc=2940067 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20507948 }} </ref> | |||
==References== | ==References== | ||
Revision as of 11:54, 25 June 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Brian Shaller, M.D. [2]
Overview
ARDS usually develops within 24 to 48 hours of the initial injury or illness and typically progresses over the course of 1 to 2 weeks (please refer to Pathophysiology of ARDS for a discussion of this topic in greater detail). Failure to diagnose and treat ARDS early on is associated with a high mortality rate and may result in lifelong complications among survivors.
Natural History
The first signs of ARDS typically present within 24 to 48 hours of the precipitating illness or injury and progress over the course of 1 to 2 weeks. The early clinical features of ARDS include:
- Hypoxemia (a declining peripheral blood oxygen saturation [SpO2] on pulse oximetry or a declining partial pressure of oxygen [PaO2] on arterial blood gas analysis) requiring high concentrations of supplemental oxygen (i.e., a higher fraction of inspired oxygen [FIO2]) or positive pressure ventilation (i.e., a higher continuous positive airway pressure [CPAP] or a higher positive end-expiratory pressure [PEEP]) in order to maintain acceptable blood oxygenation
- Tachypnea and labored breathing
- Tachycardia
- Signs or symptoms that suggest worsening of the underlying illness
Left untreated, the mortality rate from ARDS is estimated to be upwards of 70%.[1]
Complications
Long-term sequelae of ARDS are common, however, they are more likely to develop among those who do not receive early or adequate treatment. They include:
- Significant weakness due to critical illness myoneuropathy and muscle atrophy as a result of long-term immobilization, sometimes resulting in lifelong physical disability
- Impaired lung function
- Chronic ventilator dependency due to advanced weakness and atrophy of the muscles of respiration
- Pulmonary fibrosis and restrictive lung disease
- Psychiatric illness (e.g., post-traumatic stress disorder [PTSD], anxiety, depression)
- Impaired cognition
- Persistent vegetative state or brain death due to prolonged hypoxemia
The most common complications of ARDS are those associated with a prolonged ICU stay:
- Secondary or nosocomial infections (e.g., ventilator-associated pneumonia [VAP] or central line-associated blood stream infection [CLABSI])
- Venous thromboembolic events (e.g., deep vein thrombosis [DVT] or pulmonary embolism [PE])
- Gastrointestinal bleeding (often secondary to stress ulcers)
- Pressure ulcers and poor wound healing
- Muscle wasting and atrophy
Prognosis
Prognosis for patients with ARDS varies based on the severity of illness, the [[Acute respiratory distress syndrome causes|precipitating insult}}, and medical comorbidities:
- The ARDS Definition Task Force calculated 90-day morality rates for mild, moderate, and severe ARDS as 27%, 32%, and 45%, respectively[2]
- The 1-year mortality rate for patients with ARDS who survive to hospital discharge varies widely between different studies and is estimated to be anywhere from 11% to over 40%[3][4][5]
- One study of patients diagnosed with ARDS in Maryland, United States, from 1992 through 1995 calculated an in-hospital mortality rate of 36% to 52%[1]
- The mortality rate among patients with ARDS due to trauma appears to be lower than among patients with ARDS due to sepsis[6]
References
- ↑ 1.0 1.1 Reynolds HN, McCunn M, Borg U, Habashi N, Cottingham C, Bar-Lavi Y (1998). "Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base". Crit Care. 2 (1): 29–34. doi:10.1186/cc121. PMC 28999. PMID 11056707.
- ↑ ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E; et al. (2012). "Acute respiratory distress syndrome: the Berlin Definition". JAMA. 307 (23): 2526–33. doi:10.1001/jama.2012.5669. PMID 22797452.
- ↑ Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F; et al. (2003). "One-year outcomes in survivors of the acute respiratory distress syndrome". N Engl J Med. 348 (8): 683–93. doi:10.1056/NEJMoa022450. PMID 12594312.
- ↑ Linko R, Suojaranta-Ylinen R, Karlsson S, Ruokonen E, Varpula T, Pettilä V; et al. (2010). "One-year mortality, quality of life and predicted life-time cost-utility in critically ill patients with acute respiratory failure". Crit Care. 14 (2): R60. doi:10.1186/cc8957. PMC 2887181. PMID 20384998.
- ↑ Wang CY, Calfee CS, Paul DW, Janz DR, May AK, Zhuo H; et al. (2014). "One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome". Intensive Care Med. 40 (3): 388–96. doi:10.1007/s00134-013-3186-3. PMC 3943651. PMID 24435201.
- ↑ Sheu CC, Gong MN, Zhai R, Chen F, Bajwa EK, Clardy PF; et al. (2010). "Clinical characteristics and outcomes of sepsis-related vs non-sepsis-related ARDS". Chest. 138 (3): 559–67. doi:10.1378/chest.09-2933. PMC 2940067. PMID 20507948.