Acute respiratory distress syndrome physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Brian Shaller, M.D. [2]

Overview

There are no pathognomonic physical exam findings of ARDS. The most notable physical exam findings include respiratory distress as well as findings indicative of the underlying illness, injury, shock, and end organ damage.

Physical Examination

The first signs of ARDS typically present within 24 to 48 hours of the precipitating illness or injury and progress over the course of 1 to 2 weeks. The early clinical features of ARDS include:

• Hypoxemia (a declining peripheral blood oxygen saturation [SpO₂] on pulse oximetry or a declining partial pressure of oxygen (PaO₂) on arterial blood gas analysis) requiring high concentrations of supplemental oxygen (i.e., a higher fraction of inspired oxygen (FIO₂)) or positive pressure ventilation (i.e., a higher continuous positive airway pressure (CPAP) or a higher positive end-expiratory pressure (PEEP)) in order to maintain acceptable blood oxygenation
• Tachypnea
• Dyspnea
• Tachycardia
• Signs that suggest worsening of the underlying illness

The physical exam findings of a patient with ARDS vary according to the underlying cause. Common physical findings include:

Vital Signs

The presence of the following signs of shock or infection on physical examination are highly suggestive of ARDS:

• Temperature (Temp, T): Hyperpyrexia ≥ 38°C or 100.4°F) or low temperature < 36°C or 96.8°F
• Blood pressure (BP): inappropriately low, with a low mean arterial pressure (MAP)
• Heart rate (HR): rapid (tachycardia > 100 beats/minute), normal, or slow (bradycardia < 60 beats/minute)
• Respiratory rate (RR): Tachypnea > 20 breaths/minute or bradypnea < 12 breaths/minute
• Peripheral capillary oxygen saturation (SpO₂): low (< 90% on ambient air or a fraction of inspired oxygen, (FIO₂) of 21% at sea level)

Skin

• Cyanosis due to poor oxygenation
• Pallor due to poor perfusion

• Tachycardia or bradycardia on heart auscultation
• Coarse breath sounds, rhonchi, crackles, or decreased breath sounds on lung auscultation
• Cool extremities or reduced peripheral pulses due to poor perfusion

References

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