Medicines for Acute respiratory distress syndrome

What it is

Acute respiratory distress syndrome (ARDS) is a serious, life-threatening condition in which the lungs become severely inflamed and cannot provide the body with enough oxygen. It is not a disease in itself, but a serious complication that develops as a result of another severe illness or injury that damages the lungs. In ARDS, the tiny air sacs in the lungs (where oxygen passes into the blood) become inflamed and fill with fluid, so the lungs cannot work properly and the level of oxygen in the blood falls dangerously low. Common triggers of ARDS include: severe infections (such as severe pneumonia or sepsis); serious injury or trauma; inhaling harmful substances; severe illness of various kinds; and other serious conditions — ARDS can also occur as a complication of severe illness from infections such as severe influenza or COVID-19. Because ARDS develops in people who are already seriously ill, it usually occurs in hospital, often in people who are critically unwell. The main feature is severe breathlessness and a dangerously low blood oxygen level, developing over a short time, along with the effects of the underlying illness. ARDS is a medical emergency and is treated in an intensive care unit. Because the lungs cannot provide enough oxygen, the mainstay of treatment is supporting breathing and oxygen levels — usually with a ventilator (a machine that helps or takes over breathing) and oxygen — while the underlying cause is treated and the lungs are given time to recover, along with supporting the other body functions and managing complications. ARDS is serious and can be life-threatening, and the outlook depends on the cause, its severity, and the person’s overall health; some people recover, though recovery can be prolonged and some are left with longer-term effects. The key messages are that ARDS is a serious, life-threatening condition where the lungs cannot provide enough oxygen, that it develops as a complication of severe illness or injury, and that it is treated in intensive care with breathing support while the underlying cause is treated.

How it is treated

Acute respiratory distress syndrome is a medical emergency treated in intensive care, with the mainstays being supporting breathing and oxygen levels, treating the underlying cause, and supporting the body while the lungs recover. ARDS develops in people who are already seriously ill, so it is usually recognised and treated in hospital, often in an intensive care unit, and its management is complex and specialised. The central aspect of treatment is supporting the lungs and oxygen levels, because the damaged lungs cannot provide enough oxygen: this usually involves mechanical ventilation — a ventilator (breathing machine) that supports or takes over the person’s breathing and delivers oxygen, set up carefully to support oxygen levels while protecting the lungs from further damage; oxygen is given, and various techniques may be used to improve oxygen levels (such as particular ventilator settings, positioning the person on their front (proning) in some cases, and, in severe cases, advanced support). Alongside this, treating the underlying cause is essential — for example treating a severe infection (with antibiotics or other treatment), managing sepsis, treating an injury, or addressing whatever triggered the ARDS — as the lungs cannot fully recover until the cause is controlled. Supportive intensive care is also central: supporting the other organs and body functions, careful management of fluids, nutrition, preventing and treating complications (such as further infections or blood clots), and sedation and comfort as needed while the person is critically ill and supported by the ventilator. The person is closely monitored, and treatment is adjusted as their condition changes. Recovery from ARDS depends on the underlying cause and severity, the person’s overall health, and other factors, and can be prolonged: some people recover well, while others may have a longer recovery or be left with some longer-term effects (such as reduced lung function, physical weakness after critical illness, or psychological effects), and rehabilitation and follow-up support recovery for those who survive. Because ARDS is a complication of severe illness, preventing and promptly treating the conditions that can lead to it (such as severe infections) where possible is relevant, though ARDS itself is treated as it arises. The reassuring message, within the seriousness, is that ARDS is treated with intensive, specialised care — supporting breathing and oxygen while the underlying cause is treated and the lungs recover — and that some people recover, though it is a serious, life-threatening condition, and recovery can be prolonged. The key point is that ARDS is a serious complication of severe illness or injury, treated in intensive care.