How should I approach the initial management of a patient with suspected ARDS in a primary care setting?

Initial management of a patient with suspected acute respiratory distress syndrome (ARDS) in a primary care setting involves urgent recognition and prompt referral for hospital assessment and treatment.

In primary care, if ARDS is suspected—characterised by acute onset of severe breathlessness, hypoxia, and signs of respiratory distress—immediate assessment of the severity of symptoms and vital signs is essential, including oxygen saturation measurement if possible.

Because ARDS is a critical condition often requiring advanced respiratory support, invasive monitoring, and intensive care, primary care management should focus on stabilising the patient and arranging urgent transfer to secondary care. This includes:

• Assessing for signs of severe respiratory distress or hypoxia and considering sepsis as a differential diagnosis.
• Providing supplemental oxygen if available and monitoring oxygen saturation.
• Not delaying transfer by attempting complex interventions in primary care.
• Calling emergency services for urgent hospital admission.

Do not attempt to manage ARDS in primary care beyond initial supportive measures and urgent referral, as definitive diagnosis and treatment require hospital-based investigations and intensive care facilities.

Offer clear communication to the patient and carers about the seriousness of the condition and the need for urgent hospital assessment.

This approach aligns with NICE guidance on suspected acute respiratory infections and severe respiratory illness, which emphasises early recognition of severe illness, assessment for sepsis, and urgent referral for hospital care when serious illness is suspected ².