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Acute Respiratory Distress Syndrome Differential Diagnoses

  • Author: Eloise M Harman, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM  more...
 
Updated: Sep 14, 2015
 
 

Diagnostic Considerations

Other conditions to be considered include the following:

  • Pulmonary hemorrhage
  • Near drowning
  • Drug reaction
  • Noncardiogenic pulmonary edema
  • Hamman-Rich syndrome
  • Retinoic acid syndrome
  • Acute hypersensitivity pneumonitis
  • Transfusion-related acute lung injury (TRALI)
  • Acute eosinophilic pneumonia
  • Reperfusion injury
  • Leukemic infiltration
  • Fat embolism syndrome

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Eloise M Harman, MD Staff Physician and MICU Director, Pulmonary Division, Gainesville Veterans Affairs Medical Center

Eloise M Harman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American Medical Womens Association, American Thoracic Society, Phi Beta Kappa, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM Professor of Critical Care Medicine, Bioengineering, Cardiovascular Disease, Clinical and Translational Science and Anesthesiology, Vice-Chair of Academic Affairs, Department of Critical Care Medicine, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine

Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM is a member of the following medical societies: American College of Chest Physicians, Association of University Anesthetists, European Society of Intensive Care Medicine, American College of Critical Care Medicine, American Heart Association, American Thoracic Society, Shock Society, Society of Critical Care Medicine

Disclosure: Received income in an amount equal to or greater than $250 from: Masimo<br/>Received honoraria from LiDCO Ltd for consulting; Received intellectual property rights from iNTELOMED for board membership; Received honoraria from Edwards Lifesciences for consulting; Received honoraria from Masimo, Inc for board membership.

Acknowledgements

Francisco Talavera, PharmD, PhD

Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rajat Walia, MD

Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Florida College of Medicine

Disclosure: Nothing to disclose.

References
  1. Ashbaugh DG, Bigelow DB, Petty TL. Acute respiratory distress in adults. Lancet. 1967 Aug 12. 2(7511):319-23. [Medline].

  2. Bernard GR, Artigas A, Brigham KL. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994 Mar. 149(3 Pt 1):818-24. [Medline].

  3. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20. 307 (23):2526-33. [Medline].

  4. Calfee CS, Matthay MA, Eisner MD, Benowitz N, Call M, Pittet JF, et al. Active and Passive Cigarette Smoking and Acute Lung Injury Following Severe Blunt Trauma. Am J Respir Crit Care Med. 2011 Mar 18. [Medline].

  5. Glavan BJ, Holden TD, Goss CH, Black RA, Neff MJ, Nathens AB, et al. Genetic variation in the FAS gene and associations with acute lung injury. Am J Respir Crit Care Med. 2011 Feb 1. 183(3):356-63. [Medline]. [Full Text].

  6. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M. Incidence and outcomes of acute lung injury. N Engl J Med. 2005 Oct 20. 353(16):1685-93. [Medline].

  7. Luhr OR, Antonsen K, Karlsson M. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group. Am J Respir Crit Care Med. 1999 Jun. 159(6):1849-61. [Medline].

  8. Davidson TA, Caldwell ES, Curtis JR. Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA. 1999 Jan 27. 281(4):354-60. [Medline].

  9. Davey-Quinn A, Gedney JA, Whiteley SM. Extravascular lung water and acute respiratory distress syndrome--oxygenation and outcome. Anaesth Intensive Care. 1999 Aug. 27(4):357-62. [Medline].

  10. Chen CY, Yang KY, Chen MY, Chen HY, Lin MT, Lee YC, et al. Decoy receptor 3 levels in peripheral blood predict outcomes of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2009 Oct 15. 180(8):751-60. [Medline].

  11. Herridge MS, Cheung AM, Tansey CM. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003 Feb 20. 348(8):683-93. [Medline].

  12. Herridge MS, Tansey CM, Matté A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011 Apr 7. 364(14):1293-304. [Medline].

  13. Masclans JR, Roca O, Muñoz X, Pallisa E, Torres F, Rello J, et al. Quality of life, pulmonary function, and tomographic scan abnormalities after ARDS. Chest. 2011 Jun. 139(6):1340-6. [Medline].

  14. Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000 May 18. 342(20):1471-7. [Medline].

  15. Levitt JE, Vinayak AG, Gehlbach BK, et al. Diagnostic utility of B-type natriuretic peptide in critically ill patients with pulmonary edema: a prospective cohort study. Crit Care. 2008. 12(1):R3. [Medline]. [Full Text].

  16. Mekontso Dessap A, Boissier F, Leon R, Carreira S, Campo FR, Lemaire F, et al. Prevalence and prognosis of shunting across patent foramen ovale during acute respiratory distress syndrome. Crit Care Med. 2010 Sep. 38(9):1786-92. [Medline].

  17. Mekontso Dessap A, Proost O, Boissier F, Louis B, Roche Campo F, Brochard L. Transesophageal echocardiography in prone position during severe acute respiratory distress syndrome. Intensive Care Med. 2011 Mar. 37(3):430-4. [Medline].

  18. The NHLBI ARDS Clinical Trials Network. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006 May 25. 354(21):2213-24. [Medline].

  19. Connors AF Jr, Speroff T, Dawson NV. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA. 1996 Sep 18. 276(11):889-97. [Medline].

  20. Walmrath D, Günther A, Ghofrani HA, Schermuly R, Schneider T, Grimminger F, et al. Bronchoscopic surfactant administration in patients with severe adult respiratory distress syndrome and sepsis. Am J Respir Crit Care Med. 1996 Jul. 154(1):57-62. [Medline].

  21. Martin-Loeches I, Lisboa T, Rhodes A, Moreno RP, Silva E, Sprung C, et al. Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection. Intensive Care Med. 2011 Feb. 37(2):272-83. [Medline].

  22. Brun-Buisson C, Richard JC, Mercat A, Thiébaut AC, Brochard L. Early Corticosteroids in Severe Influenza A/H1N1 Pneumonia and Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2011 May 1. 183(9):1200-1206. [Medline].

  23. Cepkova M, Matthay MA. Pharmacotherapy of acute lung injury and the acute respiratory distress syndrome. J Intensive Care Med. 2006 May-Jun. 21(3):119-43. [Medline].

  24. Walkey AJ, Soylemez Wiener R. Utilization patterns and patient outcomes associated with use of rescue therapies in acute lung injury. Crit Care Med. 2011 Feb 17. [Medline].

  25. Dellinger RP, Zimmerman JL, Taylor RW. Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Inhaled Nitric Oxide in ARDS Study Group. Crit Care Med. 1998 Jan. 26(1):15-23. [Medline].

  26. Griffiths MJ, Evans TW. Inhaled nitric oxide therapy in adults. N Engl J Med. 2005 Dec 22. 353(25):2683-95.

  27. Afshari A, Brok J, Møller AM, Wetterslev J. Inhaled nitric oxide for acute respiratory distress syndrome and acute lung injury in adults and children: a systematic review with meta-analysis and trial sequential analysis. Anesth Analg. 2011 Jun. 112(6):1411-21. [Medline].

  28. The NHLBI ARDS Clinical Trials Network. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006 Jun 15. 354(24):2564-75. [Medline].

  29. Mikkelsen ME, Christie JD, Lanken PN, Biester RC, Thompson BT, Bellamy SL, et al. The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med. 2012 Jun 15. 185(12):1307-15. [Medline]. [Full Text].

  30. Lakhal K, Ehrmann S, Benzekri-Lefèvre D, Runge I, Legras A, Dequin PF, et al. Respiratory pulse pressure variation fails to predict fluid responsiveness in acute respiratory distress syndrome. Crit Care. 2011 Mar 7. 15(2):R85. [Medline].

  31. Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015 Jun 4. 372 (23):2185-96. [Medline].

  32. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000 May 4. 342(18):1301-8. [Medline].

  33. Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2004 Jul 22. 351(4):327-36. [Medline].

  34. Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010 Sep 16. 363(12):1107-16. [Medline].

  35. Jaber S, Petrof BJ, Jung B, Chanques G, Berthet JP, Rabuel C, et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med. 2011 Feb 1. 183(3):364-71. [Medline].

  36. Amato MB, Barbas CS, Medeiros DM. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998 Feb 5. 338(6):347-54. [Medline].

  37. Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010 Mar 3. 303(9):865-73. [Medline].

  38. Bellani G, Guerra L, Musch G, Zanella A, Patroniti N, Mauri T, et al. Lung Regional Metabolic Activity and Gas Volume Changes Induced by Tidal Ventilation in Patients with Acute Lung Injury. Am J Respir Crit Care Med. 2011 Jan 21. [Medline].

  39. Esteban A, Alia I, Gordo F. Prospective randomized trial comparing pressure-controlled ventilation and volume-controlled ventilation in ARDS. For the Spanish Lung Failure Collaborative Group. Chest. 2000 Jun. 117(6):1690-6. [Medline].

  40. Derdak S, Mehta S, Stewart TE. High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med. 2002 Sep 15. 166(6):801-8. [Medline].

  41. Kacmarek RM, Wiedemann HP, Lavin PT. Partial liquid ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006 Apr 15. 173(8):882-9.

  42. Gattinoni L, Tognoni G, Pesenti A. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med. 2001 Aug 23. 345(8):568-73. [Medline].

  43. Guerin C, Gaillard S, Lemasson S. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA. 2004 Nov 17. 292(19):2379-87.

  44. Morris AH, Wallace CJ, Menlove RL, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994 Feb. 149(2 Pt 1):295-305. [Medline].

  45. Bishop JF, Murnane MP, Owen R. Australia's winter with the 2009 pandemic influenza A (H1N1) virus. N Engl J Med. 2009 Dec 31. 361(27):2591-4. [Medline].

  46. Gadek JE, DeMichele SJ, Karlstad MD. Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med. 1999 Aug. 27(8):1409-20. [Medline].

  47. Pontes-Arruda A, Aragão AM, Albuquerque JD. Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med. 2006 Sep. 34(9):2325-33. [Medline].

  48. Krzak A, Pleva M, Napolitano LM. Nutrition therapy for ALI and ARDS. Crit Care Clin. 2011 Jul. 27(3):647-59. [Medline].

  49. Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, Moss M, et al. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA. 2012 Feb 22. 307(8):795-803. [Medline].

  50. Gajic O, Dara SI, Mendez JL, et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med. 2004 Sep. 32(9):1817-24. [Medline].

  51. Craig TR, Duffy MJ, Shyamsundar M, et al. A randomized clinical trial of hydroxymethylglutaryl- coenzyme a reductase inhibition for acute lung injury (The HARP Study). Am J Respir Crit Care Med. 2011 Mar 1. 183(5):620-6. [Medline].

  52. Meduri GU, Chinn AJ, Leeper KV. Corticosteroid rescue treatment of progressive fibroproliferation in late ARDS. Patterns of response and predictors of outcome. Chest. 1994 May. 105(5):1516-27. [Medline].

  53. Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med. 2006 Apr 20. 354(16):1671-84. [Medline].

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Anteroposterior portable chest radiograph in patient who had been in respiratory failure for 1 week with diagnosis of acute respiratory distress syndrome. Image shows endotracheal tube, left subclavian central venous catheter in superior vena cava, and bilateral patchy opacities in mostly middle and lower lung zones.
Photomicrograph from patient with acute respiratory distress syndrome (ARDS). Image shows ARDS in exudative stage. Note hyaline membranes and loss of alveolar epithelium in this early stage of ARDS.
Portable chest radiograph in a patient with acute respiratory distress syndrome. The condition evolved over approximately 1 week.
Portable chest radiograph in a patient with acute respiratory distress syndrome. The condition evolved over approximately 1 week.
Portable chest radiograph in a patient with acute respiratory distress syndrome. The condition evolved over approximately 1 week.
Photomicrograph from a patient with acute respiratory distress syndrome (ARDS). This image shows ARDS in the early proliferative stage. Note the type 2 pneumocytic proliferation, with widening of the septa and interstitial fibroblast proliferation.
Photomicrograph from a patient with acute respiratory distress syndrome (ARDS). This image shows ARDS in the late proliferative stage. Note the extensive fibroblast proliferation, with incorporation of the hyaline membranes.
Chest radiograph in a patient with acute respiratory distress syndrome (ARDS). The patient was treated with perflubron, which is used for partial liquid ventilation.
Portable chest radiograph. This image shows bilateral opacities that are suggestive of ARDS.
Computed tomography scan in a patient with suspected acute respiratory distress syndrome (ARDS). This image was obtained at the cardiac level with mediastinal window settings and shows bilateral pleural effusions instead of diffuse bilateral lung consolidation. In addition, the presence of some compression atelectasis in the lower lobes is observed.
High-resolution computed tomography scan in a patient with acute respiratory distress syndrome. This image demonstrates a small right pleural effusion, consolidation with air-bronchograms, and some ground-glass-appearing opacities. The findings indicate an alveolar process, in this case, alveolar damage.
ARDS, subacute 4x: low power view of lung in the organizing phase of ARDS. There is compression of alveoli by proliferating interstitial fibrous tissue but occasional hyaline membranes are still visible. Photomicrograph courtesy of Rodolfo Laucirica, M.D
ARDS, subacute 20x: higher power view of an alveolus (center) lined by hyaline membranes with proliferating interstitial fibroblasts to the left and right of center. Photomicrograph courtesy of Rodolfo Laucirica, M.D
 
 
 
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