The management and treatment of Acute Respiratory Distress Syndrome (ARDS) primarily focus on supportive care, addressing the underlying cause, and minimizing further lung injury.
### Supportive Care
1. **Mechanical Ventilation**:
- Low tidal volume ventilation to minimize barotrauma and volutrauma (6 mL/kg of ideal body weight) is the only intervention proven to improve survival in ARDS patients[2].
- Positive End-Expiratory Pressure (PEEP) is used to prevent alveolar collapse and improve oxygenation[3].
- Prone positioning can enhance oxygenation in patients with severe ARDS by improving ventilation-perfusion matching[1][5].
2. **Fluid Management**:
- A conservative fluid management strategy is often employed to prevent fluid overload and pulmonary edema, which can worsen respiratory distress[2][4][5].
3. **Pharmacological Interventions**:
- Corticosteroids may be administered early in the course of moderate to severe ARDS to reduce inflammation and the duration of mechanical ventilation[3].
- Neuromuscular blockade can be considered in early severe ARDS to improve oxygenation and ventilator synchrony[1][3].
4. **Extracorporeal Membrane Oxygenation (ECMO)**:
- ECMO is considered for severe ARDS cases when conventional mechanical ventilation fails to provide adequate oxygenation[4][5].
5. **Other Supportive Measures**:
- Prevention of complications such as deep vein thrombosis, stress ulcers, and ventilator-associated pneumonia is crucial[2].
- Nutritional support and careful monitoring of sedation and analgesia are also important[1][2].
### Addressing the Underlying Cause
- Early identification and treatment of the underlying cause of ARDS, such as infections, are critical. This includes the use of broad-spectrum antibiotics and interventions like drainage of infected fluid collections if necessary[2].
### Monitoring and Post-ARDS Care
- Continuous monitoring of oxygenation, ventilation parameters, and hemodynamic status is essential[1].
- After discharge, patients may experience long-term effects such as muscle weakness, cognitive impairment, and reduced quality of life, necessitating rehabilitation and follow-up care[1][4].
Citations:
[1] https://www.aafp.org/pubs/afp/issues/2020/0615/p730.html
[2] https://emedicine.medscape.com/article/165139-treatment
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997862/
[4] https://www.lung.org/lung-health-diseases/lung-disease-lookup/ards/ards-treatment-and-recovery
[5] https://www.mayoclinic.org/diseases-conditions/ards/diagnosis-treatment/drc-20355581