A guide for nurses and respiratory therapists for ARDS Treatment: Bridging the Gap Between Theory and Practice

Abstract

Acute respiratory distress syndrome (ARDS) remains a significant challenge in intensive care units despite advancements in management. This review provides a comprehensive overview of ARDS, focusing on fluid management strategies. The Berlin definition categorizes ARDS severity based on the degree of hypoxemia. Sepsis is the most common etiology, with other causes including pneumonia, shock, surgery, and trauma. Pathophysiologically, ARDS is characterized by increased alveolar-capillary permeability, leading to pulmonary edema and impaired gas exchange. Management involves treating the underlying cause, nutritional support, thromboprophylaxis, and lung-protective ventilation strategies. Low tidal volumes (6 mL/kg) and driving pressure are associated with improved survival. Prone positioning is recommended for severe ARDS, while the roles of inhaled nitric oxide, corticosteroids, and extracorporeal membrane oxygenation require further research. Conservative fluid management is favored over liberal strategies, as it improves oxygenation and lung function without impacting mortality. Central venous pressure and pulmonary artery wedge pressure have limitations in guiding fluid therapy. Pulse pressure variation and lung ultrasound are emerging tools for assessing fluid responsiveness and extravascular lung water, respectively. Albumin offers no advantage over crystalloids, and hydroxyethyl starch is not recommended. A restrictive transfusion strategy is appropriate in ARDS patients. Prognosis depends on the underlying cause, with sepsis-related ARDS having the lowest survival. Recent studies suggest declining mortality rates, likely due to advancements in ventilation strategies and supportive care. Further research is needed to refine management approaches and identify new therapeutic avenues for ARDS.