How should I approach the management of patients with acute respiratory distress syndrome (ARDS) in a primary care context?

In a primary care setting, the management of patients with suspected acute respiratory distress syndrome (ARDS) should focus on early recognition, supportive care, and urgent referral to secondary or emergency care. ARDS is a severe form of acute respiratory failure characterized by rapid onset of widespread inflammation in the lungs, often requiring advanced respiratory support not available in primary care NICE CKS.

Initial assessment should include a thorough clinical evaluation of respiratory distress signs such as severe breathlessness, hypoxia (oxygen saturation ≤94%), tachypnoea, and altered mental status. Use pulse oximetry to monitor oxygen saturation continuously if available NICE CKS.

Oxygen therapy should be administered promptly to maintain target oxygen saturations of 94–98% in most patients, but for those at risk of hypercapnic respiratory failure (e.g., COPD patients), aim for 88–92% saturation using controlled oxygen delivery devices such as Venturi masks NICE CKS. High-flow oxygen or reservoir masks at 15 L/min may be used initially if saturation is below 85%, but care must be taken to avoid excessive oxygen in susceptible individuals NICE CKS.

Supportive measures include sitting the patient upright to ease breathing and providing reassurance. If sepsis is suspected as an underlying cause, follow sepsis recognition protocols and refer urgently NICE CKS.

Urgent referral to hospital is mandatory for all suspected ARDS cases because definitive diagnosis and management require advanced interventions such as mechanical ventilation and intensive care, which are beyond primary care capabilities NICE CKS. Early communication with emergency services is essential to ensure rapid transfer.

Recent literature emphasizes that ARDS management is complex and typically involves invasive or non-invasive mechanical ventilation strategies tailored to lung-protective principles to minimize ventilator-induced lung injury Fujishima 2023Battaglini et al. 2023. These advanced therapies underscore the necessity of hospital referral from primary care.

In summary, primary care management of ARDS is limited to prompt recognition, oxygen supplementation with careful saturation targets, supportive care, and immediate referral for hospital-based intensive management NICE CKS Fujishima 2023Battaglini et al. 2023.