Medical Condition/Diagnosis: Acute Respiratory Distress Syndrome
Brief Patho/ Etiology
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Causes and/ or Risk
Factors
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ARDS is an acute, diffuse inflammatory lung injury characterized by hypoxemia and stiff
or noncompliant lungs.
The hallmark sign of ARDS is hypoxemia that is unresponsive to increased oxygen
delivery.
Many children diagnosed with ARDS require care in the pediatric intensive care unit.
Despite advances in modes of mechanical ventilation and a greater understanding of
how to prevent lung damage in children receiving invasive ventilation, mortality rates
remain high. The overall mortality rate in children from ARDS is approximately 24%
Direct causes of ARDS include pneumonia, aspiration of gastric contents, inhalation
injury, pulmonary contusion, pulmonary vasculitis, and near-drowning events.
Indirect causes include sepsis, major trauma, pancreatitis, severe burns, shock
(noncardiogenic), drug overdose, multiple blood transfusions, and transfusion-related
acute lung injury.
Signs and Symptoms
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Classic clinical signs of ARDS include hypoxemia, decreased lung compliance, and
bilateral opacities on a chest radiograph. A child with ARDS initially appears tachypneic
and tachycardic and has an increased work of breathing. O2 saturation level is
decreased, often despite an increase in oxygen delivery, and cyanosis may be present.
Breath sounds are decreased bilaterally.
Diagnostic Tests
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Diagnostic studies and tests include assessment of:
○ arterial blood gases for decreased PaO2
○ complete blood count (to assess white blood cell count, which may be elevated)
○ an electrolyte panel, as well as BUN and creatinine (for baseline renal function).
Chest radiographs are essential in diagnosing ARDS. Findings may include atelectasis,
infiltrates, and signs of pulmonary edema.
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Assessment
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Treatment
A complete and thorough respiratory assessment is warranted when caring for a child
with ARDS, with particular focus on signs of hypoxia.
Initially, the child is tachypneic and tachycardic with dyspnea, retractions, and use of
accessory muscles.
Auscultation of lung sounds may reveal normal lung sounds or fine, scattered crackles.
Assess and monitor closely mental status and behavior for agitation and restlessness.
As ARDS progresses and hypoxia worsens, the child may become lethargic and
somnolent.
The work of breathing increases, retractions worsen, color becomes pale or cyanotic,
and, despite increased oxygen delivery, the child cannot maintain O2 saturation levels
above 90%.
Nursing management of the child with ARDS involves primarily supportive care. Children with
ARDS are treated in the intensive care unit, because they are often intubated and mechanically
ventilated as ARDS progresses. See the section Maintain Adequate Oxygenation, for
interventions related to oxygenation.
Children with ARDS who are intubated and mechanically ventilated or who are receiving high
levels of noninvasive positive pressure ventilation are at risk for decreased cardiac output and
decreased perfusion. Administration of fluids to maintain cardiac output is often required in the
care of a child with ARDS. Monitor heart rate and blood pressure frequently. Maintain blood
pressure in the age-appropriate range. Monitor urine output, which is a key indicator of
perfusion. This is because when perfusion to the kidney is decreased owing to decreased
cardiac output, kidney function is decreased, reducing urine output. Mental status is also helpful
in monitoring perfusion. A poorly perfused brain results in lethargy, alteration in mental status,
and somnolence.
Medications often prescribed in the treatment of ARDS include antibiotics to treat infection,
diuretics to reduce pulmonary fluid, and vasodilators to decrease pulmonary vascular resistance.
Children who are diagnosed with ARDS are at high risk for kidney dysfunction and even kidney
failure. Medications that affect kidney function should be adjusted accordingly. Gastric ulcer
prophylaxis is initiated. Monitoring for side effects of these medications is essential. See the
section Maintain Adequate Hydration and Nutrition.
Nursing Diagnosis
and Goals
Nursing Interventions
and Evaluation
Patient Education