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Treatments and drugs
By Mayo Clinic staffThe first goal in treating ARDS is to get oxygen flowing to your lungs and organs until the fluid is cleared out of the lungs and they can function more normally. Treating the underlying condition then becomes equally important.
Oxygen
To get more oxygen into your bloodstream, your doctor will likely use supplemental oxygen and mechanical ventilation.
- Supplemental oxygen (noninvasive positive pressure ventilation). For milder symptoms or as a temporary measure, oxygen may be delivered through a mask that fits tightly over your nose or your nose and mouth.
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Mechanical ventilation, or breathing machine (positive pressure mechanical ventilator). Most people with ARDS also will need assisted breathing. A positive pressure mechanical ventilator pushes air into your lungs, forcing the fluid out of your air sacs. Air flows from a bedside ventilator into your windpipe (trachea) through a tube placed in your nose or mouth. If you need help breathing for more than several days, it's likely that the breathing tube will be inserted directly into your trachea through an incision in your neck (called a tracheotomy).
You remain on a ventilator until you can breathe on your own. For some people, this may be a matter of days. For others it may take weeks or even months. The longer you remain on a ventilator, the greater the chances of serious complications, including pneumonia and further lung damage. The first week of treatment is critical. People who are weaned from the ventilator within a week have the best chance of a complete recovery.
Fluids
Managing fluids carefully is crucial. In the past, doctors gave people with ARDS large amounts of fluids through an IV to keep oxygen flowing to other parts of the body. Now, doctors know that too much fluid can increase the fluid buildup in the lungs. However, depriving your body of fluids can put a strain on your heart and other organs that depend on adequate volumes of blood and oxygen to function properly. Your doctor will likely closely monitor the amount of fluids you receive so that you get just the right balance to regain lung function but protect your other organs.
Medication
People with ARDS are also given medication to prevent and treat infections, as well as relieve pain and discomfort. All people on mechanical ventilation are given comfort sedation. Sometimes it is necessary to paralyze the skeletal muscles to relax them and prevent them from "fighting" the respirator. You may also be given an anticoagulant to prevent blood clots (deep venous thrombosis) and pulmonary embolism.
In the past, corticosteroids — meant to reduce lung inflammation — were a routine part of managing ARDS. Several studies, however, have found that corticosteroid treatment has no effect on survival rates among people with ARDS.
- What is ARDS? National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Ards/Ards_WhatIs.html. Accessed March 2, 2009.
- Adult (acute) respiratory distress syndrome. American Lung Association. http://www.lungusa.org/atf/cf/%7B7a8d42c2-fcca-4604-8ade-7f5d5e762256%7D/ALA_LDD08_ARDS_FINAL.PDF. Accessed March 2, 2009.
- Deal EN, et al. Role of corticosteroids in the management of acute respiratory distress syndrome. Clinical Therapeutics. 2008;30:787.
- George KJ. A systematic approach to care: Adult respiratory distress syndrome. Journal of Trauma Nursing. 2008;15:19.
- Zambon M, et al. Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest. 2008;133:1120.
- Leaver SK, et al. Acute respiratory distress syndrome. BMJ. 2007;335:389.
