Diagnosing and Treating ARDS
How Is ARDS Diagnosed?
The diagnosis is based on your symptoms, vital signs, and a chest X-ray. There is no single test to confirm the diagnosis of ARDS. Patients with ARDS will have rapid onset of shortness of breath and very low oxygen levels in the blood. The chest X-ray will show fluid present in both lungs (often described as "infiltrates" by doctors reading chest X-rays). Since ARDS and some heart problems have similar symptoms, your doctor might perform certain tests to rule out a heart problem.
How Is ARDS Treated?
Because there is no direct cure for ARDS, treatment focuses on supporting the patient while the lung heals. ARDS will often worsen in the first few days following the diagnosis before the lung begins to heal. The goal of this supportive care is to keep enough oxygen in the blood to prevent further damage to your body and to treat whatever caused ARDS in the first place. Another important part of the care for ARDS is to prevent and manage complications related to being in an intensive care unit.
All patients with ARDS will require oxygen therapy. Oxygen alone is usually not enough, and you will likely need to be supported by a ventilator. A ventilator is a machine that delivers breaths and oxygen therapy through a tube inserted into the trachea or windpipe.
Hospitalized patients are typically in bed on their backs. However, lying face down (prone) may help improve oxygen levels in the blood and increase survival in patients with ARDS. This can be a very complicated task that takes an entire team to accomplish, and some patients may be too sick for this treatment. There are specialized beds designed to help position patients in the intensive care unit face down and, although they are convenient, they are not absolutely necessary for this therapy.
Sedation and medications to prevent movement
It is uncomfortable and painful to be supported by a ventilator. This often leads to restlessness and agitation, which can cause even more problems for the lungs. In order to keep comfortable and prevent this, the patient may need sedation to remain calm. There are medications called paralytics that can temporarily prevent patients from moving. Because the side effects related to these medications are significant, the risks and benefits need to be closely considered.
Sometimes doctors will give patients with ARDS a medication called a diuretic to help increase urination. This removes fluid from the body and can help prevent fluid from building up in the lungs. This must be done carefully, because too much fluid removal can lead to low blood pressure or kidney problems.
ECMO stands for extracorporeal membrane oxygenation. This is a very complicated treatment that takes blood outside of your body and pumps it through a membrane that adds oxygen and removes carbon dioxide and then returns the blood to your body. This is a high-risk therapy with many complications. It is not suitable for every patient.
This content was developed in partnership with the CHEST Foundation, the philanthropic arm of the American College of Chest Physicians.