Snapshot A 46-year-old woman is admitted to the medical intensive care unit with severe pancreatitis. During the first 72 hours of admission, she becomes confused with increased work of breathing. Her oxygen saturation is 82% and physical exam is remarkable for tachypnea, nasal flaring, and abdominal contractions. She is placed on mechanical ventilation. A chest radiograph demonstrates bilateral infiltrates with no evidence of cardiomegaly or pleural effusions. Introduction Definition a clinical syndrome characterized by inflammatory lung injury leading to acute hypoxemia and bilateral radiographic infiltrates Berlin Definition of ARDS login to view 4 more bullets ARDS severity login to view 6 more bullets Etiology Pneumonia (most common risk factor) Aspiration Pulmonary contusion Acute pancreatitis Sepsis Pathogenesis injury and inflammation to the alveoli increases pulmonary capillary permeability phases login to view 7 more bullets impaired gas exchange Presentation Symptoms dyspnea Physical exam tachypnea tachycardia diffuse crackles Imaging Chest radiography indication initial imaging study in the workup of ARDS Differential Diffuse alveolar hemorrhage differentiating factor in addition to acute respiratory failure, patients also have an unexplained drop in their hemoglobin concentration Vaping-associated lung disease ground-glass opacities on imaging that can progress to ARDS DIAGNOSIS Making the diagnosis based on Berlin definition Treatment Approach to treatment the goal is to maintain gas exchange while avoiding ventilator-induced lung injury Interventional mechanical ventilation indication login to view 5 more bullets settings login to view 6 more bullets Prognosis Severe ARDS has the worst mortality (45%) compared to mild and moderate