What is ARDS

What is ARDS?

Acute Respiratory Distress Syndrome (ARDS) is a frequent cause of respiratory failure (inability of the lung to provide adequate oxygen to sustain life) afflicting 150,000 Americans per year. ARDS develops rapidly in previously healthy persons. In less than 24 hours the patient goes from normal lung function to full blown disease requiring admission to an intensive care unit. Most patients are less than 50 years old, and children are frequently affected. Mortality is very high, 60% to 70%, and has not improved in the last 30 years. Patients who survive ARDS recover most of their lung function and return to their prior quality of life within a few months of hospital discharge. It is estimated that 70,000 Americans die each year as a consequence of this disease – about 1,000 in the Memphis metropolitan area. In reality, the death rate from ARDS is much higher, since many of these patients die before the disease is recognized. ARDS has a significant impact on public health, similar to that of breast or lung cancer, and much higher incidence than AIDS or leukemia. This disease is frequently unknown to the layman. Often in cases of ARDS, the media reports cause of death as a respiratory complication of an infection or surgery, failing to identify the cause as ARDS.

ARDS is precipitated by a variety of conditions which damage the blood vessels throughout the body. The lung, the organ with the largest number of blood vessels in the body, is the most seriously affected. Damage to the blood vessels causes profuse leakage of blood contents (plasma, clotting factors, red blood cells) into the airspaces of the lung. Flooding of the air passages (noncardiogenic pulmonary edema) blocks the transfer of inspired oxygen into the circulation causing a life-threatening reduction in blood oxygen levels. Oxygen is the essential fuel to maintain life. Conditions precipitating ARDS but are not limited to: infections, trauma, bleeding, drug reactions; or complications following childbirth delivery, surgery, transplantation, or chemotherapy treatment.

ARDS was first recognized during World War II when traumatized young soldiers frequently died of lung congestion after successful initial resuscitation in battlefield. In the late 1960's, with the development of modern mechanical ventilators (breathing machines), a modality to sustain life in ARDS patients finally became available. Thanks to modern intensive care technology we can now support these patients on a breathing machine for weeks. However, patients failing to improve lung function by day 7 of respiratory failure had a small chance of recovery or survival (80% mortality). Then in 1998, the MLRP published a study demonstrating an effective resolution of ARDS after Day 7 with the use of glucorticoids. In other words, the final outcome of ARDS has not significantly changed over the last 30 years; modern technology has only postponed the timing of death.

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