ARDS can be challenging to diagnose and often masquerades as another disorder or disease initially, which makes prompt treatment difficult at times. The provider starts with a medical history, which should focus on previous respiratory conditions, heart disease, recent infections, or recent travel that could have resulted in some contamination and other relevant information. The provider will complete a thorough physical assessment looking carefully for any signs of change in fluid status or inflammatory response (Grossman & Porth, 2014; Ignatavicius et al., 2018; NHLBI, 2019).
Based on the findings during the history and physical, the provider will order diagnostic studies to assess the patient’s condition further. The provider will likely order:
- arterial blood gases to determine the degree of hypoxemia and functional gas exchange,
- a complete blood count to evaluate for signs of infection,
- a complete or basic metabolic profile to assess electrolyte and fluid status as well as renal and liver function, and
- C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR) to assess for inflammation.
The provider may also order a urinalysis and urine culture to look for possible infection of the urinary and renal system. An EKG and other cardiac tests might be ordered if the patient has a previous history of cardiac disease or has symptoms suggestive of cardiac dysfunction (Grossman & Porth, 2014; Ignatavicius et al., 2018; NHLBI, 2019).
A chest x-ray will be completed to assess for the presence of fluid in the lungs or other abnormalities such as the appearance of what looks to be “ground glass” or an area of “white-out” on the x-ray. The chest x-ray can also be used to assess for infection, although a CT scan may be ordered to further evaluate for infection in the lungs as well as the abdomen. The provider may order a bronchoscopy to directly assess the lungs, take biopsies, and potentially collect a specimen for culture (Grossman & Porth, 2014; Ignatavicius et al., 2018; NHLBI, 2019).
Based on the results of the health history, physical assessment, patient condition, and the diagnostic study results, the healthcare provider will make a diagnosis that indicates ARDS or another disorder. Therefore, there is not a single diagnostic tool that allows for the diagnosis of ARDS, but rather an accumulation of studies and the physical condition of the patient (Grossman & Porth, 2014; Ignatavicius et al., 2018; NHLBI, 2019).