ABSTRACT
Acute Respiratory Distress Syndrome (ARDS) is a syndrome causing life-threatening respiratory failure, occurring within one week. Severe lung injury is usually fatal without artificial ventilation, yet positive pressure ventilation can cause ventilator-induced lung injury, once called "ventilator lung". Rescue therapies for ARDS include: prone positioning, and inverse ratio ventilation. Intra-alveolar damage increases pulmonary vascular resistance, causing pulmonary hypertension. Systemic vasodilators, such as glyceryl trinitrate may cause problematic hypotension. Fluid management in ARDS necessitates balancing problems from pulmonary oedema against perfusion needs. Neuromuscular blockade may improve oxygenation and outcome from severe ARDS but, while this may be necessary for oxygenation, adverse effects of paralysing agents should be considered. ARDS also has poor cognitive, psychological and social outcomes. ARDS may be suspected with increasing need for ventilatory support; other signs may include increasing airway pressure, new left ventricular failure and bilateral infiltrates on chest X-ray.
