From Sepsis to ARDS

Sepsis remains one of the most daunting challenges in critical care. An estimated 49 million cases of sepsis occur globally every year, and it affects 1 in 5 people worldwide. Sepsis is responsible for 11 million deaths each year — this accounts for 20% of all global deaths.

Sepsis and Acute Respiratory Distress Syndrome (ARDS) are closely linked in critically ill patients. In fact, sepsis is the most common cause of ARDS. ARDS is worse in sepsis because septic patients are often more likely to develop shock and multi-organ failure. In addition, uncontrolled inflammation damages not just the lungs but multiple organs and immune dysregulation in sepsis makes recovery even harder for these patients.

Despite advances in early recognition and sepsis bundles, the transition from infection-driven systemic inflammation to life-threatening respiratory failure is often rapid and unpredictable.

Critical care teams rely on evidence-based pillars — low tidal volume ventilation, conservative fluid management, prone positioning, and timely use of neuromuscular blockade to improve the chances of survival. But even with these tools, ARDS secondary to sepsis is difficult to manage.

The journey from sepsis to ARDS underscores the complex interplay of infection, inflammation, and organ failure. Managing patients with both sepsis and ARDS presents significant challenges for critical care teams due to the complexity, rapid progression, and multi-organ involvement of these conditions. They must ensure key measures are in place, including early recognition, timely intervention, antibiotic therapy, fluid and haemodynamic management, ventilation strategies, prone positioning, organ support, sedation, monitoring and reassessment.

The situation doesn't always have to be grim. There is potential for improvement in the management of patients who transition from sepsis to ARDS. The important thing is to recognise the signs early and understand the relationship that exists between sepsis and ARDS.

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