Acute respiratory distress syndrome (ARDS) is defined by acute diffuse inflammatory lung injury invoked by a variety of systemic or pulmonary insults. Despite medical progress in management, mortality remains 27% to 45%. Patients with ARDS should be managed with low tidal volume ventilation. Permissive hypercapnea is well tolerated. Conservative fluid strategy can reduce ventilator and hospital days in patients without shock. Prone positioning and neuromuscular blockers reduce mortality in some patients. Early management of ARDS is relevant to emergency medicine. Identifying ARDS patients who should be transferred to an extracorporeal membrane oxygenation center is an important task for emergency providers.
Key points
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Severe acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by acute bilateral pulmonary infiltrates occurring after a recognizable trigger and a Pa o 2 to fraction of inspired oxygen (F io 2 ) ratio of less than 100.
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Patients with all severities of ARDS should be managed with a low tidal volume strategy, safe plateau pressures, and fluid restriction as tolerated by hemodynamics.
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Patients with severe ARDS should receive early neuromuscular blockade and consideration for prone ventilation. Patients with severe ARDS not responding to therapy should be transferred to an ECMO center.
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