How to Diagnose Acute Respiratory Distress Syndrome

Before going into details on how to efficiently diagnose acute respiratory distress syndrome (ARDS), we’ll have a quick overview and some signs and symptoms.


Acute respiratory distress syndrome (ARDS) develops due to the building up of fluids inside the alveoli or the microscopic, elastic sacs of air inside the lungs. This build-up of fluid will prevent or make it difficult for the lungs to be filled in with air, resulting in limited oxygen reaching the bloodstream. Decreased oxygen in the body compromises the entire system from working properly.


ARDS usually happens to people who are severely ill or those who have experienced critical injuries. As for those who already have ARDS, most of them do not survive, and the risk of mortality increases with the illness’ severity and age. As for those who do survive, they either have irreversible lung damage or will recover completely.

Signs and Symptoms

The manifestations of ARDS change with intensity, and will significantly depend on the illness’ severity and cause; not to mention the presence of an underlying lung or heart disease. Some of the common signs and symptoms of ARDS are:

  • Shortness of breath (SOB)
  • Decreased blood pressure
  • Extreme fatigue
  • Confusion
  • Rapid and labored breathing


How do we diagnose ARDS? How does one say that the client needs to be taken to the ICU as soon as possible? Here are the main criteria to accurately diagnose ARDS in a client:

  1. Erroneous breathing

One of the main criteria for diagnosing ARDS is the inconsistency in breathing patterns since the lungs are primarily affected.

  1. Oxygen saturation (SaO2)

If a post-operative client’s oxygen saturation has been steadily below 90% Sa02, it is one of the main indicators for ARDS.

  1. Partial pressure of oxygen (PaO2)

The doctor will also order out an ABG test to see how much PaO2 or oxygen is going back to the pulmonary artery. If the result is anything less than 60%, that’s another criterion for ARDS.

  1. Power of hydrogen (pH)

If the pH result is less than 7.30, this means that the blood’s acidity is high and will immediately affect the lungs.

To summarize, here are the things that healthcare practitioners should watch out for when trying to diagnose ARDS:

  • SaO2 – less than 90%
  • PaO2 – less than 60%
  • pH – less than 7.3


Aside from distressed breathing, if the results show the indicators mentioned above, all it means is that the lungs are filling up with carbon di-acid or carbon dioxide, which makes it hard for the client to breathe.

While oxygen is not going inside the lungs and to the rest of the body, carbon dioxide is building up. Therefore, it is expected that carbon dioxide can go as high as 50mEq/L. This will cause the blood to become very acidic.

So, now that we are well aware of how acute respiratory distress syndrome is diagnosed, we will now proceed to the stages based on the severity of the illness; all this and more in our next article.

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Acute Respiratory Failure or Acute Respiratory Distress Syndrome

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Respiratory failure is a lung issue that happens when there is insufficient oxygen passing through the lungs and into the blood. For proper functioning of the different parts of the body, it needs ample amount of oxygen in the blood.

Going into this respiratory failure lecture, there will be ventilation problems versus oxygen exchange problems. There are a couple of reasons for acute respiratory failure to happen.

Mechanical Issues

There would be instances when you’ll be having trouble in getting that oxygen down to the lungs which can be caused by certain medical conditions like a decreased diaphragm function, myasthenia gravis, or other neurological problems that can affect the muscles of the lungs.

Chronic obstructive pulmonary diseases (COPD) and pulmonary embolism are other types of mechanical problems that can affect proper lung functioning. Taking deep breaths would be difficult and sometimes painful. A broken rib and a pneumothorax are also conditions that can prevent the client from doing deep breaths and getting sufficient ventilation.

Quality of Exchange

In terms of quality of oxygen-blood exchange, this will focus on how much oxygen is integrated into the blood’s hemoglobin. The quality entirely depends on the oxygen that’s coming inside the lungs which can be influenced mainly by decreased atmospheric oxygen – like when you’re climbing on top of a mountain.

Low atmosphere affects the lungs and becomes a problem due to the lack of oxygen; this is quite unusual unless your client climbs mountains.

Low Hemoglobin

Low hemoglobin or low volume in the blood means that there is an insufficient amount of hemoglobin to carry oxygen to various parts of the body. Though there is enough oxygen coming inside the body, the blood’s hemoglobin level is not adequate to carry all that oxygen around.

Increased Lung Fluid

On the other hand, if there’s a blockage between the hemoglobin and the oxygen like there is too much fluid inside the lungs, it’s another reason to have respiratory failure.

Increased lung fluid tends to block oxygen to jump from the alveoli into the hemoglobin of the blood. A wet lung or an edematous lung can block the quality of oxygen that’s being distributed into the system. The moment this happens, it will lead to acute respiratory distress syndrome (ARDS).

Acute Respiratory Distress Syndrome

Take note: acute respiratory failure will eventually lead to acute respiratory distress syndrome.

This is like saying that a client who has sepsis has undergone septic shock and has systemic inflammatory response syndrome (SIRS) criteria. This is not three separate things, but they are actual problems ranging from small, medium, and large.

So, acute respiratory failure will eventually lead to a diagnosis stating that your client is in acute respiratory distress syndrome which is a severe lung problem.

On our next article, we’ll discuss on knowing how to identify a client who is suffering from acute respiratory distress syndrome.

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Nursing Interventions for Acute Respiratory Distress Syndrome

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ARDS stands for acute respiratory distress syndrome – these are just some fancy words for a condition that’s causing severe alveoli inflammation leading to structural collapse and instability.

The Alveoli

For those who are unaware what alveoli are, they are those small sacs located at the end portion of the respiratory tract. You can think of them as apples attached to the branches of your trees (lungs).

It is in the alveoli that oxygen and carbon dioxide exchange happens. When people inhale oxygen, it is exchanged with carbon dioxide (CO2) that is breathed out by the body. In acute respiratory distress syndrome, this process is compromised due to the mass of fluid pooling inside, causing lung collapse.

Nursing Intervention for ARDS

Fluid rushing into the respiratory tract and reaching the alveoli is the primary cause for ARDS. So, how does one manage and intervene? How do you make sure that you’re decompressing and minimizing inflammation to the respiratory tract? What are the important nursing interventions that you need to do?

  1. Give Corticosteroids

Some common corticosteroids are Solu-Medrol and Prednisone. Clients are given corticosteroids to decrease inflammation in the respiratory tract. Take note; if you provide corticosteroids to your client with ARDS, you are also decreasing the movement of WBCs, thereby decreasing the immune response.

  1. Give Antibiotics

Since ARDS is a condition wherein there’s a pooling of liquid inside the lungs, the water becomes stagnant and is prone to becoming grounds for bacterial growth. Therefore, the client is likely to developing pneumonia. For this reason, antibiotics are necessary to protect the respiratory tract from developing complications and get rid of inflammation.

Remember that the primary goal why antibiotics are given is to alleviate inflammation and bring the client’s breathing back to normal.

  1. Turn the Client

Put the client in a 45-degree or 90-degree sitting position, and turn your client every hour to make sure that the fluid inside the lungs is not stagnant in one place. This will give parts of the lungs to breathe. Moving the client will also facilitate drainage as steroids are provided.

Critical Thinking

Here’s a critical thinking question:

As a nurse caring for a client with the late phase of acute respiratory distress syndrome, between diuretics and IV fluids, which one would you give to your client and why?

Answer: Neither.

First, this is a trick question. Second, the answer is neither because you should not give IV fluids nor diuretics to your ARDS client due to fluid considerations.

Intravenous fluids are not given because the lungs are already filled with fluid and, as the nurse in charge, you do not want to introduce further fluids that will add up to the ones that are already pooling inside the lungs.

On the other hand, diuretics are not given due to perfusion issues. Diuretics can cause concentrated blood, making it harder for hemoglobin and oxygen to move around the body. You have to make the most of the oxygen that’s left inside the body to be properly distributed to different parts and systems.


Remember, antibiotics and corticosteroids are essential in preventing infection and decreasing inflammation so that the fluid will not progress into multiple complications like pulmonary fibrosis or multi-organ dysfunction syndrome (MODS). Hopefully, this nursing intervention will reverse the condition, and the client will regain normal breathing.

That’s ARDS in a nutshell. For more relevant nursing topics, visit

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!