Synopsis
Recognise ARDS as acute inflammatory hypoxaemic respiratory failure, treat its precipitant, and deliver lung-protective critical care with timely proning and ECMO referral when conventional support is failing.
- ARDS is acute hypoxaemic respiratory failure from diffuse inflammatory lung injury with bilateral opacities not primarily explained by heart failure, collapse or pleural fluid.
- Common precipitants are pneumonia, non-pulmonary sepsis, aspiration, pancreatitis, major trauma, transfusion and inhalational injury; more than one trigger may coexist.
- Establish timing, oxygenation severity and the level of PEEP or CPAP, but never delay supportive care to complete a formal label.
Key red flags
A recent insult followed by increasing oxygen need, tachypnoea and bilateral opacities with no dominant hydrostatic explanation should prompt early ICU review even before invasive ventilation.
Investigation priorities
Quantify oxygenation, ventilation and acid-base trajectory and support severity assessment.
Management branches
Acute hypoxaemia with new bilateral pulmonary opacities.
- Start monitored oxygen support and involve ICU early while documenting timing, FiO2, blood gases and work of breathing.
- Search immediately for pneumonia, sepsis, aspiration, trauma, pancreatitis, transfusion, inhalation, drug injury and immune haemorrhage.
Key medicines
Cause-directed antimicrobial therapyGive promptly under the current NICE sepsis and local pneumonia protocol, adjusted for source, allergy, renal function, microbiology and exposure history.
Sedation and analgesia for protective ventilationUse the lowest effective ICU protocol regimen, titrated to a documented sedation target, ventilator synchrony and daily reassessment.