Acute respiratory distress syndrome (ARDS)

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Última revisão: 15 Aug 2025

Última atualização: 31 May 2024

Acute respiratory distress syndrome (ARDS) typically presents with dyspnea and hypoxemia, which progress to acute respiratory failure.

Common causes are pneumonia, sepsis, aspiration, and severe trauma.

Mortality is between 30% and 50%.

Low tidal volume, plateau-pressure-limited mechanical ventilation is the primary treatment that has been shown to reduce mortality. In severe ARDS, neuromuscular blockade, prone positioning, and extracorporeal membrane oxygenation (ECMO) may improve clinical outcomes.

Complications include pneumothorax, ventilator-associated pneumonia, multiple organ failure, and pulmonary fibrosis with prolonged respiratory failure.

This topic covers ARDS in patients over the age of 12 years.

Definição

Acute respiratory distress syndrome (ARDS) is a noncardiogenic pulmonary edema and diffuse lung inflammation syndrome that often complicates critical illness. The clinical definition of ARDS was updated in 2024 to include both intubated and nonintubated patients and to allow diagnosis of ARDS in resource-limited settings.[1] Diagnosis of ARDS is based on fulfilling three criteria:

Acute onset (within 1 week)
Bilateral opacities on chest radiography or computed tomography (CT), or bilateral B lines and/or consolidations on ultrasound not fully explained by effusions, atelectasis, or nodules/masses
PaO₂/FiO₂ (arterial to inspired oxygen) ratio of ≤300 or SpO2/FiO2 (pulse oximetric saturation to inspired oxygen) ratio of ≤315.[1]

If no risk factors for ARDS are present, then acute pulmonary edema as a result of heart failure should be ruled out.

História e exame físico

Principais fatores diagnósticos

low oxygen saturation
acute respiratory failure

Detalhes completos

Outros fatores diagnósticos

critically ill patient
dyspnea
increased respiratory rate
pulmonary crepitations
low lung compliance
fever, cough, pleuritic chest pain
frothy sputum

Detalhes completos

Fatores de risco

sepsis
aspiration
pneumonia
severe trauma
blood transfusions
lung transplantation
pancreatitis
history of alcohol misuse
burns and smoke inhalation
drowning
e-cigarette and vaping product use
Immunotherapy
drug overdose
cigarette smoking

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

chest x-ray
arterial blood gases
sputum culture
blood culture
urine culture
amylase and lipase

Detalhes completos

Investigações a serem consideradas

brain natriuretic peptide (BNP)
echocardiogram
pulmonary artery catheterization
bronchoalveolar lavage or endotracheal aspirate
CT scan of the thorax
Lung ultrasound
viral testing
open lung biopsy

Detalhes completos

Algoritmo de tratamento

AGUDA

all patients

Colaboradores

Autores

Lorraine B. Ware, MD

Ralph and Lulu Owen Professor of Medicine

Professor of Pathology, Microbiology and Immunology

Director

Vanderbilt Medical Scholars Program

Division of Allergy, Pulmonary and Critical Care Medicine

Department of Medicine

Vanderbilt University School of Medicine

Nashville

Declarações

LBW has received consulting fees from Arrowhead, Akebia, Santhera, and Global Blood Therapeutics, all unrelated to the topic of this article. LBW has received research funding (to her institution) from the US National Institutes of Health, Boerhinger Ingelheim, and Genetech Inc., unrelated to the topic of this article. LBW holds stock in Virtuoso Surgical, unrelated to the topic of this article.

Agradecimentos

Dr Lorraine Ware would like to gratefully acknowledge Dr Richard Fremont, a previous contributor to this topic.

Declarações

RF declares that he has no competing interests.

Revisores

Michael A. Matthay, MD

Director of Medicine Critical Care Fellowship

Department of Anesthesia and Perioperative Care

University of California San Francisco

Declarações

MAM declares that he has no competing interests.

Timothy Evans, MBBS

Professor of Intensive Care Medicine

Royal Brompton Hospital

London

Declarações

TE declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Matthay MA, Arabi Y, Arroliga AC, et al. A new global definition of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2024 Jan 1;209(1):37-47.Texto completo Resumo

Bos LDJ, Ware LB. Acute respiratory distress syndrome: causes, pathophysiology, and phenotypes. Lancet. 2022 Oct 1;400(10358):1145-56.Texto completo Resumo

Janz DR, Ware LB. Approach to the patient with the acute respiratory distress syndrome. Clin Chest Med. 2014 Dec;35(4):685-96.Texto completo Resumo

Qadir N, Sahetya S, Munshi L, et al. An update on management of adult patients with acute respiratory distress syndrome: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2024 Jan 1;209(1):24-36.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Coronavirus disease 2019 (COVID-19)
- Acute heart failure
- Bilateral pneumonia
Mais Diagnósticos diferenciais
Diretrizes
- Mechanical ventilation in adult patients with acute respiratory distress syndrome
- Symptom assessment for mechanically ventilated patients: principles and priorities
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Acute respiratory distress syndrome (ARDS)

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

all patients

Colaboradores

Autores

Lorraine B. Ware, MD

Declarações

Agradecimentos

Declarações

Revisores

Michael A. Matthay, MD

Declarações

Timothy Evans, MBBS

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice