Dealing with the onset and course of ARDS.
What to expect?
The seriousness and the unpredictability of ARDS is extremely
frustrating and can be emotionally devastating for patients, family, friends, and for
doctors and nurses as well. Hopefully, current and future research will make ARDS a
more treatable and hence much less serious and more predictable illness than it is now.
Very few cases of ARDS are alike. Some people get better
quickly within a matter of several days and others take weeks or months to improve.
Some people have no complications and others seem to develop every possible complication
of ARDS. Finally, some will die quickly while others die after a long and trying
The course of events after ARDS has developed is determined, in
part, by the degree of abnormality in lung function and in part by the illness or injury
that led to the development of ARDS. Most patients need to be on the ventilator for
several days. If the underlying medical condition has stabilized and no new
complications develop, then it is likely that the lungs will begin to heal, allowing the
patient to do more and more of the breathing on his or her own, and the ventilator may be
removed within a week. This happens in about a third of the patients with ARDS.
In another third of the patients, the underlying condition is so
severe that even intensive therapy is not able to reverse the abnormalities. Such
patients may have, or develop, progressive or irreversible damage to other vital organs.
Sometimes the healing process is further compromised by chronic illnesses or
advanced age. Although intensive medical care is sometimes able to prolong survival
by a few days, such patients often die within the first week.
Those who survive the first week but whose ARDS has not yet improved
enter what might be termed the "chronic phase" of ARDS. These patients
need to be on the ventilator for up to three or four weeks and sometimes longer. Sometimes
this happens because of the original injury or illness, but often it occurs because of
other complications. Even when there is a satisfactory response to treatment of the
underlying condition, a small number of patients have persistent inflammation in the lung
and seem unable to begin the healing process. The outcome in patients who enter this
chronic phase is dependent on reversing the inflammation and preventing or treating
complications, especially infection. Sometimes unusual or experimental treatments
may be considered.
About half of the patients with "chronic" ARDS will get
better and leave the hospital, but recovery is slow and may be incomplete.