Wednesday, March 5, 2008

Acute Respiratory Distress Syndrome


The cause of ARDS is not well known. Current scientific information supports several theories about its development, but the precise reason ARDS occurs remains unknown. What is known, however, is that ARDS can come about by either of two basic mechanisms.

The first is a direct physical or toxic injury to the lungs. Examples include inhalation of vomited stomach contents (aspiration), smoke or other toxic fumes, and a severe 'bruising' of the lungs that usually occurs after a severe blow to the chest.

The second mechanism is more common, but less understood. This is an indirect, blood-born injury to the lungs. When a person is very sick or the body is severely injured, some chemical signals are released into the bloodstream. These signals reach the lung, and the lung reacts by becoming inflamed, thus causing lung failure. Examples of this type of indirect lung injury include the presence of severe infection (sepsis) and severe injury (trauma) - the two most common factors in ARDS cases. Other examples are severe bleeding (resulting in massive blood transfusions), severe inflammation of the pancreas (pancreatitis) and some types of drug overdoses.

ARDS has generally been characterized into three stages. In full-blown cases, these three stages unfold sequentially over a period of several weeks to several months.

1 Exudative stage: Characterized by accumulation in the alveoli of excessive fluid, protein and inflammatory cells that have entered the air spaces from the alveolar capillaries. The exudative phase unfolds over the first 2 to 4 days after onset of lung injury.

2 Fibroproliferative (or proliferative) stage: Connective tissue and other structural elements in the lungs proliferate in response to the initial injury. Under a microscope, lung tissue appears densely cellular. Also, at this stage, there is a danger of pneumonia sepsis and rupture of the lungs causing leakage of air into surrounding areas.

3 Resolution and Recovery: During this stage, the lung reorganizes and recovers. Lung function may continue to improve for as long as 6-12 months and sometimes longer, depending on the precipitating condition and severity of the injury. It is important to remember that there may be and often are different levels of pulmonary recovery amongst individuals who suffer from ARDS.

Treatment primarily involves supportive care in an intensive care unit (ICU), including use of a mechanical ventilator (vent) and supplemental oxygen. The goal of mechanical ventilation is to support the patient's breathing during the time needed for the patient's lungs to heal. Good progress has been made recently in improving the use of ventilators.

The seriousness and unpredictability of ARDS can emotionally devastate patients, family, friends, as well as doctors and nurses, especially since very few cases of ARDS are alike. Some patients get better quickly within several days, and others take weeks or months to improve. Some patients have no complications and others seem to develop every possible complication of ARDS. Finally, some victims die quickly, while others die after a long and trying illness.

While ARDS is a very serious syndrome, people can and do survive! It is important family and friends of the patient remain hopeful, and seek guidance from others, including ARDS survivors, families and friends of survivors.

From Matt:

Statistically over 60% of ARDS patients survive and although that might be daunting it is important to note that the underlying causes of this syndrome are yet to be determined. When it was first defined in the late 1960's it was 100% fatal. I am grateful that we live in a time where medical science can give us 60% and family powerful in the spirit to make up the 40% we need.

My experiences with Colton have been marked by a deep respect and love for him. He (and his brothers) are much finer men then I ever was at that age. When someone complains about teenagers not living up to the standards set by the generations that preceded them, I always think of the Stewart boys and the great kindness they continue to share with those around them especially to my parents. My heart and continued respect goes out to Colton and his family whom I love deeply.

Sources and resources:


Neil said...

Thank you Matt....I really needed to read your research..and especially to read the wonderful words you had to say about Colton and his brothers. I think they are special boys, too. I know that through the collective faith and prayers of our family, we can cause miracles. I have great hope for that miracle this time. Auntie V.

It's Just me! said...

Oh great! You've got me bawling again! Thanks for the additional info on ARDS. He is one amazingly tough boy and with our great families faith and prayers, he will be well again! I just feel strongly about that.

Ashley Webb said...

Thanks Matt. Has there been any update on his progress yet? How did this happen? Has he been sick for a while, or was it an unexpected thing? Sorry so many questions, I just haven't been told any details about his condition. We'll definitely fast and pray for him.
Ashley Webb (Campbell, Smith) :)

Big Red Cat said...

This is from Diana's initial email:
I'm not sure if anyone else emailed you but I thought I would tell you at least what I know. Hopefully Ang or Gary got a chance to drop a line and let you know what they know (which is more than me). Anyway, like I told Dad, Colton is at MVH ICU. He became ill with what they thought was the stomach flu last Sunday evening. This continued until Wednesday and Ang and Gary were starting to get concerned but realized that so many flu's are going around right now that a doctor would certainly just turn them away. Well Wednesday night his temperature got to 105.7 and so they took him to the ER. He was told he had the flu but he was dehydrated and so they pumped him full of 3 bags of fluid and some potassium before sending him home. They had also mentioned that his white blood count was high but that is not unusual for what he was dealing with. They gave him Phenegrin, which stopped his vomiting but he started with what seemed like respiratory problems. Fast breathing and sweating and coughing. He was completely lethargic all week and didn't even turn on a TV or anything, but slept.

He continued to get worse. And by Saturday Ang was concerned about his really quick breathing. I told her he sounded like he had pneumonia, after what I had been through. She called and got him into the clinic for urgent care. The doctor was quick and NOT thorough obviously because he didn't check his saturation or anything and sent him and Gary home saying it was just the flu and he would get better. Today he continued to deteriorate and was struggling to breathe and was grey in color. They quickly took him to the ER. He was not only diagnosed with pretty bad pneumonia but is also septic. His blood pressure was not stable, his heart rate was 180, his kidney's were not functioning properly. They intubated him and put a breathing tube in with oxygen at 100% and are treating him vigorously with antibiotics. We rushed over to the ICU to be with Ang and Gary and had the chance to go in and see him. He looks terrible! He became unstable a few times while we were there as they worked to reach the fine line between unconscious and keeping his blood pressure stable. It was scary! We had all the men come and were all able to go in with them to give him another blessing. Dr. Bennion is treating him and we are glad for that. He is telling it like it is though and it is frightening to realize just how sick this boy is! Dr. Dinkins came up later from the ER and told Ang he felt good about him recovering but told her this would be a long process. And that he might not be back to himself until mid to late Summer. Most likely won't return to school for a month or so. He is hoping that they will be able to take him off the oxygen in 3-5 days if all goes well. It's touch and go right now though.