Q&A: ARDS versus acute respiratory distress
Q: I saw that there are separate codes for acute respiratory distress syndrome (ARDS) and acute respiratory distress. What’s the difference between ARDS and acute respiratory distress?
A: Acute respiratory distress is considered a symptom, as demonstrated by the fact it is classified to R06.03. R codes, falling to Chapter 18 of the code set classify symptoms, signs, and abnormal clinical and laboratory findings. Respiratory distress describes a situation where the patient demonstrates difficulty breathing, a situation in which the patient must work harder to breathe, or to obtain adequate oxygenation. Indicators that support respiratory distress include:
- Rapid respiratory rate
- Cyanosis
- Grunting on expiration
- Nasal flaring
- Retractions under the breast bone and rib cage
- Diaphoresis
- Wheezing
- Body positioning to improve breathing
ARDS, on the other hand, is not a symptom; it is a definitive diagnosis. It’s classified by the code J80. ARDS is a rapidly progressive disease occurring in critically ill patients. The main complication in ARDS is that fluid leaks into the lungs making breathing difficult or impossible.
The causes of ARDS are divided into two categories: direct or indirect injuries to the lung. Some of the direct injuries to the lung include pneumonia, aspiration, near drowning, trauma, and smoke inhalation. The indirect injuries to the lung include inflammation of the pancreas, sepsis, blood transfusions, burns, and medication reactions.
There is no cure for ARDS and treatment focuses on supporting the patient and allowing the injured lung to heal. The goal is to maintain oxygenation and perfusion of oxygen to the body’s organs. Depending on the patient’s condition, this supportive care could include assisting with oxygenation to include ventilator support with continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), intubation and vent, or extracorporeal membrane oxygenation (ECMO). We would also support organ function and fluid management.
For more information about the difference between ARDS and acute respiratory distress, I suggest reading this article published by the ACDIS CDI Regulatory Committee.
Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, CDI education director at HCPro in Middleton, Massachusetts, answered this question. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps, click here.