When breathing becomes difficult and oxygen levels drop, every second matters. Acute Respiratory Distress Syndrome, or ARDS, can develop quickly and requires expert care to restore healthy lung function.
At Gwinnett Pulmonary, we treat ARDS by improving oxygen levels, supporting lung recovery, and addressing the underlying cause of the condition.
We use advanced treatments such as mechanical ventilation, oxygen therapy, and medications to stabilize breathing and protect vital organs. Our team monitors each patient closely and adjusts care to match their specific needs.
At Gwinnett Pulmonary, we focus on both immediate treatment and long-term lung health. We guide each person through recovery with therapy, education, and preventive strategies to lower the risk of future lung problems.
Acute Respiratory Distress Syndrome (ARDS) causes severe inflammation and fluid buildup in the lungs, leading to poor oxygen exchange. We focus on how it is defined, how it develops, and how often it occurs in different patient groups.
We define ARDS as a type of acute lung injury marked by widespread inflammation and fluid leakage into the alveoli. This results in non-cardiogenic pulmonary edema, meaning the cause is not heart failure.
According to the Berlin Definition, diagnosis requires:
| Severity | PaO₂/FiO₂ Ratio (mmHg) | PEEP ≥ 5 cm H₂O |
| Mild | 201–300 | Required |
| Moderate | 101–200 | Required |
| Severe | ≤100 | Required |
These criteria help us identify ARDS early and guide the level of respiratory support needed.
ARDS progresses through three overlapping phases: exudative, proliferative, and fibrotic.
In the exudative phase, damage to the alveolar-capillary membrane allows protein-rich fluid to leak into the alveoli. We see diffuse alveolar damage and hyaline membrane formation, which interfere with gas exchange.
The proliferative phase involves partial repair. Type II alveolar cells multiply to restore the lining, and inflammation begins to subside.
In the fibrotic phase, some patients develop scarring that stiffens the lungs and reduces compliance. This stage can lead to long-term respiratory impairment.
ARDS affects patients across many settings, especially those in intensive care. It often results from pneumonia, sepsis, trauma, or aspiration.
The incidence of ARDS varies by region and diagnostic criteria. Studies suggest it occurs in about 10% of ICU patients and up to 25% of those requiring mechanical ventilation.
Mortality rates range from 30% to 45%, depending on severity and underlying conditions.
We also recognize that ARDS remains underdiagnosed, particularly in mild cases.
Acute Respiratory Distress Syndrome (ARDS) develops when the lungs experience widespread inflammation and fluid buildup. It often occurs as a complication of serious illness or injury rather than as a primary condition.
Understanding the leading causes and risk factors helps us identify patients early and begin treatment promptly.
ARDS can result from both direct and indirect injury to the lungs.
Direct causes include pneumonia, aspiration of stomach contents, near drowning, and pulmonary contusion from chest trauma. These conditions directly damage the alveoli and surrounding tissue.
Indirect causes involve systemic problems such as sepsis, pancreatitis, or significant trauma outside the chest. In these cases, inflammatory chemicals released into the bloodstream injure the lung’s capillaries.
We often see sepsis as the most frequent trigger, followed by severe pneumonia. Both conditions cause fluid to leak into the air sacs, preventing regular oxygen exchange.
Other contributing events include massive transfusions, burns, and drug reactions that lead to acute lung injury.
Certain factors increase the chance of developing ARDS once asignificantr illness or injury occurs. People with chronic alcohol use, smoking history, or obesity face higher risk because their lungs and immune systems are already stressed.
Hospitalized patients, especially those in intensive care, are more vulnerable. Prolonged mechanical ventilation, blood transfusions, and major surgeries can all raise the likelihood of ARDS.
We also consider age and preexisting lung or heart disease essential risk factors.
The table below summarizes key risk contributors:
| Category | Examples |
| Direct Lung Injury | Pneumonia, aspiration, drowning, pulmonary contusion |
| Indirect Injury | Sepsis, pancreatitis, trauma, transfusion reactions |
| Patient Factors | Smoking, alcohol use, obesity, advanced age |
Because ARDS causes rapid breathing and low oxygen levels, we must rule out other conditions that look similar. Cardiac failure and congestive heart failure can also cause fluid buildup in the lungs, but their origin is heart-related rather than inflammatory.
We use echocardiography, chest imaging, and blood tests to distinguish ARDS from these cardiac causes. In ARDS, the heart usually functions normally, while the lungs show widespread inflammation and noncardiogenic pulmonary edema.
Accurate diagnosis ensures that we provide the proper treatment—supporting oxygenation and addressing the underlying cause rather than focusing solely on heart function.
We focus on improving oxygen levels, stabilizing breathing, and preventing further lung damage. Our team uses evidence-based methods that combine careful monitoring, advanced respiratory support, and individualized treatment plans to help patients recover safely and maintain long-term lung function.
We begin by performing a detailed evaluation to confirm acute respiratory distress syndrome (ARDS) and identify its cause. This includes reviewing the patient’s medical history, physical exam, imaging studies, and blood tests to assess oxygenation and organ function.
Patients with severe respiratory failure are admitted to the intensive care unit (ICU) for close observation. In the ICU, we monitor oxygen saturation, heart rate, and blood pressure continuously.
Our team adjusts treatment based on how the lungs respond to oxygen therapy and ventilation. We also identify and treat any underlying issues, such as infection or trauma, that may have triggered ARDS.
Early ICU admission allows us to deliver rapid, coordinated care that supports both breathing and circulation.
Our primary goal is to maintain adequate oxygen levels and reduce stress on the lungs. Mechanical ventilation is often used to deliver low tidal volumes and prevent further lung injury.
We may provide supplemental oxygen, IV fluids, and medications to manage pain, sedation, or infection. We use a balanced fluid strategy to prevent fluid buildup in the lungs while maintaining blood pressure and organ perfusion.
When needed, diuretics help achieve a negative fluid balance. Supportive care also includes preventing blood clots, protecting the stomach from ulcers, and encouraging early physical therapy when the patient is stable.
These measures improve comfort and help preserve long-term quality of life after ICU discharge.
We monitor patients closely to ensure that oxygen delivery meets the body’s needs without causing further lung injury. Pulse oximetry and arterial blood gas tests guide us in adjusting oxygen levels and ventilator settings.
Our target is to maintain oxygen saturation between 88% and 95%, depending on the patient’s condition. We review changes in breathing patterns, chest imaging, and lab results daily.
If oxygenation remains poor despite standard therapy, we may consider advanced options such as prone positioning or extracorporeal membrane oxygenation (ECMO).
Continuous monitoring and timely adjustments help us stabilize patients and support recovery from hypoxemia and respiratory failure.
We use a range of respiratory support techniques to stabilize oxygen and carbon dioxide levels, protect the lungs, and reduce complications. Our approach focuses on maintaining gas exchange while avoiding further lung injury through careful ventilator management and advanced supportive therapies.
We apply lung-protective ventilation to limit ventilator-induced lung injury. This method uses small tidal volumes (4–6 mL per kg of ideal body weight) and keeps plateau pressure below 30 cm H₂O.
These settings reduce barotrauma and volutrauma, which can worsen lung inflammation. We adjust positive end-expiratory pressure (PEEP) to keep alveoli open and improve oxygenation without causing overdistension.
PEEP levels are guided by oxygen response and lung compliance. When standard modes are not effective, we may use airway pressure release ventilation (APRV) or high-frequency oscillatory ventilation (HFOV) in select patients.
These options maintain oxygenation while reducing excessive pressure swings.
| Key Parameter | Typical Target | Purpose |
| Tidal Volume | 4–6 mL/kg IBW | Prevent overdistension |
| Plateau Pressure | <30 cm H₂O | Limit barotrauma |
| PEEP | Individualized | Improve oxygenation |
For patients with mild to moderate respiratory distress, we may start with noninvasive ventilation (NIV) or high-flow nasal cannula (HFNC). These methods deliver oxygen without intubation and can reduce the need for invasive mechanical ventilation.
Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) provide constant or variable pressure to keep airways open. HFNC delivers heated, humidified oxygen at high flow rates, improving comfort and reducing work of breathing.
We monitor patients closely for worsening oxygen levels or fatigue. If noninvasive support fails to maintain adequate gas exchange, we proceed with invasive ventilation to prevent further deterioration.
Prone positioning improves oxygenation by redistributing lung perfusion and ventilation. We typically maintain patients in the prone position for 16 hours per day when oxygen levels remain low despite optimized ventilator settings.
Recruitment maneuvers temporarily increase airway pressure to reopen collapsed alveoli. We perform these cautiously to prevent hemodynamic instability or barotrauma.
Combining prone positioning with appropriate PEEP and low tidal volume ventilation often enhances oxygenation and reduces mortality in severe ARDS. These interventions require a coordinated team to ensure safety and effectiveness.
When severe ARDS does not respond to conventional ventilation, we consider veno-venous extracorporeal membrane oxygenation (V-V ECMO). This system circulates blood through an external membrane that removes carbon dioxide and adds oxygen, allowing the lungs to rest.
We select ECMO candidates based on factors such as oxygenation index, plateau pressure, and overall organ function. ECMO can be combined with extracorporeal carbon dioxide removal (ECCO₂R) to manage hypercapnia in less severe cases.
While ECMO improves gas exchange, it carries risks including bleeding and infection. Our team continuously monitors anticoagulation, circuit performance, and ventilator settings to maintain safety and optimize outcomes.
We use a combination of medications and supportive measures to manage inflammation and improve oxygenation in patients with acute respiratory distress syndrome (ARDS). These treatments aim to stabilize lung function while allowing time for recovery.
We often use corticosteroids such as dexamethasone to decrease lung inflammation and improve oxygen exchange. These drugs help reduce alveolar damage caused by the body’s immune response.
Glucocorticoids can shorten the duration of mechanical ventilation in some patients. Their use requires careful timing and dosing to avoid side effects like infection or muscle weakness.
| Common Agent | Typical Purpose | Key Consideration |
| Dexamethasone | Reduce inflammation | Monitor glucose and infection risk |
| Methylprednisolone | Improve oxygenation | Adjust dose by severity |
In cases of severe ARDS, we may use neuromuscular blocking agents (NMBAs) to improve ventilator synchrony and oxygenation. These medications temporarily relax respiratory muscles, allowing for more controlled ventilation and reduced lung strain.
Short-term use, often within the first 48 hours, can help prevent ventilator-induced lung injury. Agents like cisatracurium are preferred for their predictable effects and short duration.
Sedation accompanies NMBAs to ensure patient comfort and safety. We monitor depth of sedation closely to minimize complications such as muscle weakness or delirium after discontinuation.
Inhaled nitric oxide (iNO) acts as a selective pulmonary vasodilator. It improves oxygenation by directing blood flow to better-ventilated areas of the lung.
While iNO can provide short-term relief, evidence shows it does not reduce mortality, so we reserve it for rescue therapy. Other adjuncts may include inhaled prostacyclins or vitamin C in investigative settings.
These therapies aim to support gas exchange and reduce oxidative stress.
Patients with acute respiratory distress syndrome (ARDS) face serious short- and long-term challenges. Survival depends on the severity of lung injury, response to treatment, and the presence of other organ problems.
Even after recovery, many patients experience lasting effects that require ongoing care and rehabilitation.
ARDS carries a high mortality rate, often ranging from 30% to 45% depending on severity and comorbidities. Mortality increases when patients develop multiorgan failure or require prolonged mechanical ventilation.
We evaluate prognosis using oxygenation levels, lung compliance, and imaging findings. Chest radiography often shows bilateral infiltrates and helps track improvement or worsening.
The American Thoracic Society recommends using standardized criteria such as the Berlin definition to assess severity and outcomes. Age, sepsis, and underlying health conditions also influence survival.
Early recognition and careful management of fluid overload and pulmonary edema improve oxygenation and reduce ventilator days.
ARDS treatment can lead to several complications. Pneumothorax may occur from high airway pressures during ventilation, requiring chest tube placement.
Decreased lung compliance in the proliferative and fibrotic phases makes ventilation more difficult and prolongs recovery. Multiorgan failure is a significant concern, especially in severe cases.
The kidneys, heart, and liver may be affected by low oxygen levels or inflammation. Preventing infection, managing sedation, and providing nutritional support are key parts of care.
Patients often experience muscle weakness and delirium from extended stays in the intensive care unit. We use early mobilization and physical therapy to reduce these risks and support faster recovery.
Recovery from ARDS continues long after discharge. Many survivors report fatigue, shortness of breath, and reduced exercise tolerance for months.
Pulmonary rehabilitation helps improve strength and breathing efficiency. We monitor patients for signs of fibrotic changes that can cause long-term stiffness in the lungs.
Regular follow-up with chest imaging and lung function tests helps track progress. Emotional and cognitive effects, such as anxiety and memory issues, are also common.
A structured rehabilitation plan addressing both physical and mental health supports better long-term quality of life.
Treating Acute Respiratory Distress Syndrome (ARDS) requires far more than short-term respiratory support—it demands precision, vigilance, and long-term dedication to lung recovery. At Gwinnett Pulmonary & Sleep, every aspect of care is guided by evidence-based practices and delivered by specialists who understand the critical nature of this condition. From mechanical ventilation and oxygen therapy to rehabilitation and patient education, each phase of treatment is designed to stabilize breathing, support healing, and rebuild lung capacity. Our goal is not only to help patients recover from an acute episode but also to prevent recurrence and safeguard long-term respiratory health. Through compassionate care and close monitoring, patients are empowered to regain control of their breath and their lives.
Breathe easier with the region’s leading pulmonary specialists.
At Gwinnett Pulmonary & Sleep, our board-certified pulmonologists provide advanced treatment for ARDS and other complex respiratory conditions. With state-of-the-art equipment, individualized treatment plans, and multidisciplinary coordination, we help patients recover safely and maintain lifelong lung health.
Book your appointment today at gwinnettlung.com or call 770-995-0630 to schedule your consultation.
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