Acute Respiratory Distress Syndrome: Disease Progression

Today, we will be discussing the progression of acute respiratory distress syndrome (ARDS) in a simplified manner.

Here we go.

Stages of ARDS

  1. Early Stage

In the early stages of acute respiratory distress syndrome, fluid accumulates interstitially within the pulmonary spaces. What does this mean? Interstitially means that the fluid, blood, pus, and white blood cells are not yet inside the lungs but are surrounding the lungs. This is termed as fluid in interstitial spaces.

            Fluid in interstitial spaces = fluid outside and around the lungs

  1. Late Stage

The second phase through the fourth phase of acute respiratory distress syndrome is called late stage.

In this stage, interstitial fluid shifts into the alveoli. This just means that the alveoli are now wet and crackles are apparent. Crackles of the lungs are one of the primary manifestations of late-stage ARDS.

            Late stage = crackles of the lungs

Take note: Clients who suffer from ARDS will not manifest crackles during the early stages but instead have clear lungs with just decreased breath sounds. The crackles become prominent two days later as the alveoli become wet and damaged.

  1. Third Stage – Next 10 Days

Within this time, you have fluid that has already occupied the lungs, and pulmonary fibrosis occurs.

Pulmonary fibrosis is just a fancy term for burned lungs. Unfortunately, when something gets burned, it’s impossible to get it unburned. Therefore, clients who have progressed to the third and fourth stages of ARDS will continuously and chronically have burned lungs that could lead to systemic inflammatory response syndrome (SIRS).

Acute respiratory distress syndrome is technically just alveoli inflammation; however, if untreated and progressed, it can lead to systemic inflammatory response syndrome. SIRS is the inflammation of the entire respiratory tract that causes shifting of the fluid into the lungs itself which then creates a breakdown.

Aside from having total inflammation of the respiratory tract, this could also lead to multiple organ dysfunction syndrome (MODS).

            10 Days = pulmonary fibrosis = progression can cause SIRS and MODS

  1. Fourth Stage

Oxygen is compromised at this stage. The client is hypoxic (PaO2 is less than 60) and is acidic (less than 7.30 pH level). PaO2’s normal level is around 18 to 20.

How does a client become acidic?

When oxygen has been distributed it to the various parts of the body, carbon dioxide (CO2) waste is transported back to the lungs to be breathed out. However, since you have impaired, charred lungs, CO2 cannot be adequately exhaled resulting in increased CO2 or carbon di-acid in your body and especially your lungs. Carbon dioxide will most likely be greater than 50, and the pH is expected to go high as well; both leading to an impaired exchange of oxygen.

            Fourth stage = hypoxic and acidic = no production line of exchanging oxygen

Client Care

A mechanical ventilator is used for clients with severe ARDS. Your clients are expected to be hooked to a vent for the rest of their lives so they can breathe minimally. What is the importance of catching pulmonary fibrosis before it progresses?

  • Reverse side effects
  • Give treatment to decrease alveoli inflammation within the respiratory tract

On our next topic, we will be discussing the therapeutic modalities of clients with ARDS. Catch you in our subsequent discussion!