What's the treatment for adult respiratory distress syndrome?
People with ARDS must be treated in a hospital, often in the intensive care unit. The objective of treatment is to provide enough support for the failing respiratory system (and other systems) until these systems have time to heal. Treatment of
the underlying condition that caused ARDS is essential.
Oxygenation must be maintained, and the underlying cause of acute lung injury corrected. Meticulous attention is necessary to prevent nutritional depletion, O2 toxicity, superinfection, barotrauma, and renal failure, which may be worsened by intravascular volume depletion. To make sure the patient gets enough oxygen until the lung injury has had time to heal. If oxygen delivered by a face mask is not enough, the patient is placed on a ventilator, which takes over breathing, and, through a tube placed in the nose or mouth (or an incision in the windpipe), forces oxygen into the lungs. This treatment must be closely supervised, and the pressure adjusted so that too much oxygen is not delivered.
The main supportive treatment of the failing respiratory system in ARDS is mechanical ventilation (a breathing machine) to deliver high doses of oxygen and a continuous level of pressure called PEEP (positive end-expiratory pressure) to the damaged lungs. Although patients with ARDS initially may be managed while breathing spontaneously with supplemental oxygen, hypoxemia is progressive and many patients require intubation and mechanical ventilation. Initial settings commonly used are the assist-control mode with provision of adequate positive end-expiratory pressure (PEEP). The use of high Fio2 concentration has been associated with pathologic changes in the lung such as edema, alveolar thickening, and fibrinous exudate. To avoid this toxicity, the Fio2 should be titrated toward 0.60 as long as oxygen saturation can be maintained at 90 percent or higher.
Liquid ventilation is performed by filling the lung with a perfluorocarbon, a low surface tension liquid with a high affinity for oxygen and carbon dioxide. Suggested mechanisms of action are prevention of alveolar collapse in the filled lung, efficient removal of mucus and debris, and possible clearance of injury-producing cytokines. Liquid ventilation has shown an improvement in oxygenation and lung compliance when used in neonates. Clinical trials in adults with partial and full liquid ventilation are ongoing.
Medications, such as antibiotics and steroids, may also be used to treat infections and reduce inflammation. The amount of oxygen needed decreases as the lungs heal. During treatment, intravenous fluids are given to prevent dehydration and provide nutrition. Pneumonia and other site-specific infections should be adequately treated with antibiotics based on appropriate culture and sensitivity. Sedation and paralytics may be required for patients who are managed with nonconventional modes of ventilation. Nutrition, preferably administered by the enteral route, is recommended. The inclusion of eicosapentaenoic acid from fish oil showed an improvement in ventilation requirements and length of stay for ARDS patients in the intensive care unit. |
