Acute Respiratory Distress Syndrome-ARDS Criteria,Predisposing Factors

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)

Introduction Predisposing Factors and Clinical Features

Related topics

Lab Investigations and Pathophysiology

Management and Prognosis

Dr Vishal Dublish, Dr Ira Shah

ARDS is a clinical syndrome first described by military physicians during World War I & II. Initially "A" stood for "adult" to differentiate it from infantile RDS. But now "A" stands for "acute". ARDS is characterized by:

Increased permeability of alveolar capillary membrane.
Diffuse alveolar damage.
Accumulation of proteinaceous pulmonary edema.

Originally most definitions of ARDS required three general criteria:

Severe hypoxemia
Reduced pulmonary compliance and
Diffuse pulmonary infiltrates on chest X-RAY

Recently American - European consensus conference proposed a new definition of ARDS, which is new uniformly accepted.

	Timing	Oxygenation	X-ray chest	Pulmonary artery Occlusion pressure
Acute lung Injury (ALI)	Acute Onset	PaO2 / FiO2 < 300 mm Hg (regardless of PEEP)	Bilateral Infiltrate	< 18 mm Hg or No evidence of left Atrial Hypertension
ARDS	Acute Onset	PaO2 / FiO2 < 200 mm Hg (regardless of PEEP)	Bilateral Infiltrate	< 18 mm Hg or No evidence of left Atrial Hypertension

Predisposing factors:

Direct injury to alveolar epithelium

Aspiration of gastric contents
Diffuse pulmonary infection
Toxic inhalation
Near drowning etc

Indirect lung injury via hematogenous delivery of inflammatory mediators

Severe sepsis
Trauma (non-thoracic)
Hypertransfusion
Pancreatitis
Falciparum malaria
Cardiopulmonary bypass, etc.

Clinical features:
ARDS usually occurs within 4-5 days of the initial at-risk diagnosis in majority of patients. In more than 50% of patients, ARDS develops in the first 24 hours. Earliest clinical sign is tachypnea followed by dyspnea.

Next : Lab Investigations and Pathophysiology

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