Complications

Complication
Timeframe
Likelihood
short term
medium

Mortality for patients with ARDS is estimated at 30% to 50%.[4][142]

short term
medium

Can develop in any patient who requires mechanical ventilation for more than 48 hours.

Signs and symptoms include a new fever, elevated white blood cell count, new infiltrate on chest x-ray, increased or changing pulmonary secretions, and hypotension.

Hospital-acquired pneumonia

short term
medium

In addition to respiratory failure, the most common manifestations in patients with ARDS are renal failure, shock, acute delirium, or coma. Less common are hepatic and haematological failure.

Treatment includes supportive therapy as well as specific interventions for each organ: mechanical ventilation for respiratory failure, dialysis for renal failure, and vasopressors for hypotension.

short term
low

Most often a complication due to pulmonary barotrauma. Barotrauma occurred in 13% of patients enrolled in the ARDS Network low tidal volume trial and was associated with higher levels of positive end-expiratory pressure (PEEP).[148]

Signs and symptoms include tracheal deviation, sudden worsening hypoxaemia, high peak and plateau pressures on the ventilator, hypotension, and cardiovascular collapse.

Chest x-ray can confirm the presence of a pneumothorax. Treated with insertion of a chest tube.

Pneumothorax

variable
high

Persistent dyspnoea is particularly present during exercise. A majority of patients who survive ARDS have a mild to moderate decrease in carbon monoxide diffusion in the lung, but steady improvement is seen in the first year.[146][147]

Assessment of dyspnoea

variable
medium

In one study, 40% of patients had either restriction or obstruction 1 year after ARDS, but similar abnormalities were not observed in another study.[146][147]

variable
medium

Studies looking at quality-of-life scores found a reduction in quality of life for at least the first year after surviving ARDS.[146][147]

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