What Is ARDS?

Acute respiratory distress syndrome, or ARDS, is a condition in which harmful amounts of fluid collect in your lungs and interfere with breathing. This reduces the amount of oxygen that enters your bloodstream and that reaches your organs.

ARDS is life-threatening and requires immediate medical attention.

Respiratory distress syndrome (RDS) is a serious health condition that commonly affects newborns, especially premature babies. Many babies born earlier than 34 weeks develop this condition, which affects a baby’s breathing. Most newborns with RDS need extra help to breathe properly in the first few days — sometimes weeks — of life.

Causes?

ARDS occurs when small blood vessels in your body leak fluid into your lungs. The underlying cause of this leak varies, but it generally happens after an injury or illness.

Neonatal respiratory distress syndrome happens when a baby’s air sacs (in the lungs) don’t function properly. This is due to the lack of surfactant, a liquid made by the lungs that helps to keep airways open. When a baby’s body doesn’t produce enough of this substance — which can happen when a baby is born too soon — it makes breathing difficult. Without treatment, babies with RDS will struggle to breathe on their own.

Acute respiratory distress syndrome causes:

• Sepsis—This is the most common underlying cause of ARDS. Sepsis is a severe infection in your bloodstream.
• Injury—You might suffer a serious injury to your head or chest that impacts your lungs.
• Pollutants—If you inhale harmful substances such as chemicals or smoke, you might damage your lungs.
• Pneumonia—Severe pneumonia can negatively impact your lungs.
• Coronavirus (COVID-19)—There is a correlation between serious cases of COVID-19 and developing ARDS.
• Other Causes—Burns, pancreas inflammation, and blood transfusions can lead to ARDS.

Symptoms?

Infants with respiratory distress syndrome may experience different symptoms to varying degrees. If you have any reason to believe your baby may be struggling to breathe, you should seek immediate medical care.

Common symptoms of RDS include:

• Headaches
• Difficulty breathing, which starts soon after birth and gets worse
• Fast Breathing
• Rapid Pulse
• Signs of low oxygen intake, such as a blue tint to baby’s skin
• Fever
• Tiredness
• Flaring nostrils or noisy breathing, both of which may signal that baby is struggling to breathe
• Quick, short breaths
• Dry Cough
• Weakness
• Confusion
• Chest retractions, when the skin by the ribs sucks in as baby breathes
• Grunting
• Discolored skin or nails
• Low blood pressure

Risk Factors

Acute respiratory distress syndrome often results from an underlying condition. There are several risk factors for developing ARDS. 

Risk factors:

• Age
• Chronic lung disease
• History of substance use and abuse
• Toxic shock
• Liver failure

Age

Older adults are more at risk than younger people for developing ARDS. As you get older, your lungs naturally get weaker and have a harder time moving oxygen through your body.

Chronic Lung Disease

If you suffer from chronic lung disease, you are more susceptible to getting ARDS. People with chronic lung disease have heightened levels of inflammation in their lungs. Inflammation can impact lung function.

History of Substance Use and Abuse

Prolonged use of tobacco products and abuse of alcohol can harm your liver and lungs. Smoking is an irritant to the lungs. This irritability can cause inflammation that leads to ARDS.

Toxic Shock

Toxic shock is a severe illness caused by a widespread infection of bacteria. Infection is the most common cause of ARDS. 

Liver Failure

Liver failure is when your liver stops working. It can cause death or serious and permanent damage to your body. The liver filters toxins from your body. When your liver stops working, more toxins stay in your body and can result in infections and inflammation.

Diagnosis?

ARDS is a serious, life-threatening condition that requires emergency care. After a physical exam, your doctor may use a variety of tests to make an ARDS diagnosis. There is no single test to diagnose the disease.

Diagnostic tests for acute respiratory distress syndrome:

• Chest X-Ray—Your doctor will take images of your chest to look for fluid-filled sacs in your lungs.
• CT scan—Your doctor will use a computed tomography (CT) scan to look for abnormalities in your body, including your lungs.
• Blood test—This test can identify the oxygen levels in your blood. Low oxygen levels are a sign of ARDS. 
• Blood pressure—Lower than usual blood pressure is a marker of acute respiratory distress syndrome.
• Echocardiogram—This machine uses sound waves to capture images of your heart. Your doctor will examine your heart to rule out heart problems.
• Electrocardiogram—This machine records and measures the electrical signals of your heart to check your heart function.
• Airway inspection—Your doctor may inspect your airway to determine the best way to treat your condition. Your doctor will also look for any obstructions that impact your breathing.
• Swabs of nose and throat—Swabs help your doctor identify any viruses present in your body.

Immediately after babies are born, a medical team closely examines them, including their breathing ability, for potential health concerns. If doctors suspect a newborn may have respiratory distress syndrome, they can perform one or more tests, including:

• Chest X-ray, which alerts doctors to any abnormalities of the heart or lungs
• Blood tests, which measures oxygen levels in the blood or check for other infections
• Echocardiography, which is a type of ultrasound technology that can rule out a heart-related cause of a breathing issue

Complications

You may experience complications from acute respiratory distress syndrome. Complications can occur during your stay in the hospital or after you leave the hospital. Some of the complications are serious.

Possible ARDS complications:

• Weak muscles—Muscle weakness is a reduction in muscle strength. It can affect your movement and mobility. For example, you may have trouble moving your arms, legs, and neck.
• Confusion—Low oxygen and high carbon dioxide in your body can change your mental status. You may experience confusion or delirium.
• Collapsed lung—A collapsed lung is a life-threatening condition in which the injured lung does not expand when you breathe.
• Blood clots— ARDS can cause blood clots such as deep vein thrombosis, which is a blood clot in your leg, or pulmonary embolism, a blood clot that travels to your lungs.
• Anxiety and depression—You may experience a range of psychological and emotional responses to living with ARDS. Acute respiratory distress syndrome may significantly impact your life, health, work, and relationships.
• Post-traumatic stress disorder (PTSD)—You may develop symptoms related to PTSD because of the impact of ARDS on your mobility, limitations, and quality of life.

Treatment?

Acute respiratory distress syndrome treatment usually involves oxygen, fluids, and medication. The first and primary step in treatment is usually to manage the oxygen levels in your body.

ARDS Treatment

• Oxygen—Your doctor will deliver oxygen into your body through a mask or ventilator. Oxygen is necessary for the organs in your body to function properly.
• Fluids—Your doctor will balance the fluid levels in your body. High fluid levels can accumulate in your lungs. Low fluid levels can also harm your organs.
• Medication—Your doctor may prescribe pain medicine to reduce discomfort, antibiotics to fight infections, and blood thinners to prevent blood clots.

The way doctors care for a baby with RDS will depend on the specific circumstances and health challenges a baby faces. At Baptist Health, our neonatal specialists have experience treating many different health conditions that affect newborns, including RDS.

If your baby has respiratory distress syndrome, your doctor may recommend:

• Breathing aids: Oxygen therapy or breathing devices, such as nasal continuous positive airway pressure (NCPAP) machine, can help babies breathe until their lungs are able to take over on their own. Sometimes, a special tube may need to be placed into a baby’s windpipe to help them breathe temporarily.
• Surfactant replacement: Doctors sometimes give artificial surfactant through a breathing tube to help a baby’s lungs work better.
• Medication: Depending on a baby’s symptoms, medication may help calm a baby or relieve pain as medical teams perform necessary treatment procedures.

With the right treatment, many infants with RDS start getting better after three to four days. Babies with RDS may need to spend a few days (or longer) in a NICU until they are healthy enough to head home.

A NICU is specifically designed to care for babies who need extra help in the first days and weeks of life outside the womb. In the NICU, a neonatal care team watches babies closely, providing a high level of care for any baby that should need extra attention.

Prevention

You can help prevent ARDS with lifestyle changes. However, there is no scientifically proven way to entirely prevent ARDS.

ARDS prevention:

• Get medical care quickly.
• Stay up to date with your flu and pneumonia vaccines.
• Quit smoking and using any tobacco products.
• Avoid secondhand smoke.
• Reduce alcohol use or stop all alcohol use.