Acute respiratory distress syndrome: Supportive care and oxygenation in adults
- Mark D Siegel, MD
Mark D Siegel, MD
- Professor of Medicine
- Yale University School of Medicine
The acute respiratory distress syndrome (ARDS) previously had a mortality rate greater than 50 percent . Mortality has since declined [2-6], but the precise mortality rate is uncertain because estimates tend to be higher in observational studies than randomized trials (figure 1) [7-9]. No single change in the management of ARDS can explain the decrease in mortality, which is likely due to multiple factors (improved approaches to mechanical ventilation and supportive care) .
The Berlin Definition of ARDS (published in 2012) has replaced the American-European Consensus Conference’s definition of ARDS (published in 1994) [10,11]. However, it should be recognized that most evidence is based upon prior definitions. The current diagnostic criteria for ARDS are provided separately. (See "Acute respiratory distress syndrome: Clinical features and diagnosis in adults", section on 'Diagnostic criteria'.)
Supportive care and the treatment of severe hypoxemia in patients with ARDS are discussed here. Epidemiology, diagnosis, etiologies, pathophysiology, clinical manifestations, prognosis, mechanical ventilation, and novel therapies are discussed in detail elsewhere. (See "Acute respiratory distress syndrome: Clinical features and diagnosis in adults" and "Acute respiratory distress syndrome: Epidemiology, pathophysiology, pathology, and etiology in adults" and "Mechanical ventilation of adults in acute respiratory distress syndrome" and "Acute respiratory distress syndrome: Novel therapies in adults".)
A minority of patients with ARDS die from respiratory failure alone [3,12-14]. More commonly, such patients succumb to their primary illness or to secondary complications such as sepsis or multiorgan system failure. (See "Evaluation and management of suspected sepsis and septic shock in adults".)
Patients with ARDS require meticulous supportive care, including intelligent use of sedatives and neuromuscular blockade, hemodynamic management, nutritional support, control of blood glucose levels, expeditious evaluation and treatment of nosocomial pneumonia, and prophylaxis against deep venous thrombosis (DVT) and gastrointestinal (GI) bleeding.
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- SUPPORTIVE CARE
- Hemodynamic monitoring
- Nutritional support
- Glucose control
- Nosocomial pneumonia
- DVT prophylaxis
- GI prophylaxis
- Venous access
- MANAGEMENT OF HYPOXEMIA
- Supplemental oxygen
- Fluid management
- Ancillary measures
- - Prone positioning
- - Decrease oxygen consumption
- - Increase oxygen delivery
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS