Acute respiratory distress syndrome natural history, complications, and prognosis
Acute respiratory distress syndrome Microchapters |
Differentiating Acute respiratory distress syndrome from other Diseases |
---|
Diagnosis |
Treatment |
Case Studies |
Acute respiratory distress syndrome natural history, complications, and prognosis On the Web |
American Roentgen Ray Society Images of Acute respiratory distress syndrome natural history, complications, and prognosis |
FDA on Acute respiratory distress syndrome natural history, complications, and prognosis |
CDC on Acute respiratory distress syndrome natural history, complications, and prognosis |
Acute respiratory distress syndrome natural history, complications, and prognosis in the news |
Blogs on Acute respiratory distress syndrome natural history, complications, and prognosis |
Directions to Hospitals Treating Acute respiratory distress syndrome |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Brian Shaller, M.D. [2]
Overview
If left untreated, 70% of patients with ARDS may progress to mortality.[1] Common complications to ARDS include weakness, impaired lung function, and brain death. Prognosis for patients with ARDS is generally poor and varies based on the severity of illness, the precipitating insult, and medical comorbidities.
Natural History
The natural history of ARDS is marked by three histopathological phases—exudative, proliferative, and fibrotic phase—each correlated to distinctive clinical manifestations.
Exudative Phase
The exudative phase typically encompasses the first 5 to 7 days of illness after exposure to one or more precipitation factors. Histopathologically, loss of integrity of the alveolar barrier results in influx of proteinaceous fluid into the air place and formation of hyaline membrane. Pulmonary edema and atelectasis with reduced pulmonary compliance ensue, leading to the development of intrapulmonary shunting and hypoxemia. In this phase, patients experience respiratory symptoms including dyspnea, tachypnea, increased work of breathing that eventually lead to respiratory failure.
Proliferative Phase
The proliferative phase generally lasts from day 7 to day 21. Histopathologically, reparative processes take place in the injured alveoli, including organization of exudates, a shift to lymphocyte-predominant infiltrates, and proliferation of type II pneumocytes. In this phase, patients may recover from acute respiratory distress despite the persistence of residual symptoms. Patients who do not recover during this phase develop progressive lung injury and early changes of fibrosis.
Fibrotic Phase
Complications
Complications of ARDS are common and more likely to develop among patients who do not receive early or adequate treatment. They include:
- Significant weakness due to critical illness myoneuropathy and muscle atrophy as a result of long-term immobilization
- Impaired lung function
- Chronic ventilator dependency due to advanced weakness and atrophy of the muscles of respiration
- Pulmonary fibrosis and restrictive lung disease
- Psychiatric illness, including post-traumatic stress disorder (PTSD), anxiety, and depression
- Impaired cognition
- Persistent vegetative state or brain death due to prolonged hypoxemia
Common complications of ARDS associated with a prolonged ICU stay include:
- Secondary or nosocomial infections (e.g., ventilator-associated pneumonia (VAP) or central line-associated blood stream infection (CLABSI))
- Venous thromboembolic events (e.g., deep vein thrombosis (DVT) or pulmonary embolism (PE))
- Gastrointestinal bleeding (often secondary to stress ulcers)
- Pressure ulcers and poor wound healing
- Muscle wasting and atrophy
Prognosis
Prognosis for patients with ARDS is generally poor and varies based on the severity of illness, the precipitating insult, and medical comorbidities:[1][2][3][4][5][6]
- 90-day morality rates for mild, moderate, and severe ARDS as 27%, 32%, and 45%, respectively
- 1-year mortality rate for patients with ARDS who survive to hospital discharge varies widely and is estimated to be beween 11% to over 40%
- Between 1992-1995, an in-hospital mortality rate between 36%-52%
- Lower mortality rate among patients with ARDS due to trauma compared patients with ARDS due to sepsis
References
- ↑ 1.0 1.1 Reynolds HN, McCunn M, Borg U, Habashi N, Cottingham C, Bar-Lavi Y (1998). "Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base". Crit Care. 2 (1): 29–34. doi:10.1186/cc121. PMC 28999. PMID 11056707.
- ↑ ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E; et al. (2012). "Acute respiratory distress syndrome: the Berlin Definition". JAMA. 307 (23): 2526–33. doi:10.1001/jama.2012.5669. PMID 22797452.
- ↑ Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F; et al. (2003). "One-year outcomes in survivors of the acute respiratory distress syndrome". N Engl J Med. 348 (8): 683–93. doi:10.1056/NEJMoa022450. PMID 12594312.
- ↑ Linko R, Suojaranta-Ylinen R, Karlsson S, Ruokonen E, Varpula T, Pettilä V; et al. (2010). "One-year mortality, quality of life and predicted life-time cost-utility in critically ill patients with acute respiratory failure". Crit Care. 14 (2): R60. doi:10.1186/cc8957. PMC 2887181. PMID 20384998.
- ↑ Wang CY, Calfee CS, Paul DW, Janz DR, May AK, Zhuo H; et al. (2014). "One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome". Intensive Care Med. 40 (3): 388–96. doi:10.1007/s00134-013-3186-3. PMC 3943651. PMID 24435201.
- ↑ Sheu CC, Gong MN, Zhai R, Chen F, Bajwa EK, Clardy PF; et al. (2010). "Clinical characteristics and outcomes of sepsis-related vs non-sepsis-related ARDS". Chest. 138 (3): 559–67. doi:10.1378/chest.09-2933. PMC 2940067. PMID 20507948.