Chest infections and ARDS claim 4 lives in federal capital

Islamabad :Chest infections including pneumonia and acute respiratory distress syndrome (ARDS) which are not given due attention by individuals and a number of clinicians in local set-ups claimed as many as four lives at one of the public sector hospitals of the federal capital in last one week.

In this region of the country, winter season has almost set in and the number of cases of chest infections including both upper and lower respiratory tract infections along with acute respiratory distress syndrome (ARDS) is on the rise.

Data collected by ‘The News’ on Sunday has revealed that Pakistan Institute of Medical Sciences received as many as 270 patients with serious chest infections last week of which 34 were hospitalized for treatment while 11 were with complaints of ARDS.

The chest infections and ARDS claimed four lives at PIMS last week, said Senior Consultant Intensive Care Medicine at Pakistan Institute of Medical Sciences Dr. Muhammad Haroon while talking to ‘The News’.

He added that ARDS is an unrecognized, under diagnosed and frequently missed disease that when gets severe, has a mortality rate of 40 to 60 per cent in USA and 60 to 80 per cent in Pakistan even after best treatment in an intensive care unit. However, outside ICU the mortality remains 100 per cent in moderate to severe ARDS, he said.

Studies reveal that ARDS occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to function.

Symptoms of ARDS can vary in intensity, depending on its cause and severity, as well as the presence of underlying heart or lung disease. They include severe shortness of breath, labored and unusually rapid breathing, low blood pressure, confusion and extreme tiredness and fatigue.

According to Dr. Haroon, as many as 32 patients out of a total 65 patients of ARDS reported at PIMS died of the syndrome in 2016 while in 2015, 68 died of ARDS out of total 103 patients reported at PIMS.

In 2014, PIMS received a total of 82 patients with ARDS of which 56 could not survive while in 2013, the syndrome claimed 43 lives at PIMS and the total patients of ARDS reported at PIMS were 69, said Dr. Haroon.

However, he added, that among the patients died of ARDS in PIMS in last four years, many were not having chest infections instead they were suffering from Sepsis, Burns, Trauma, pancreatitis etc.

He added majority of cases still occurred in winters in patients with chest infections. The most important factor among survivors was the early recognition and early diagnosis with early intubation and early ICU admission, he said.

He explained that the mechanism of ARDS is fluid leaked from the smallest blood vessels in the lungs into the tiny air sacs where blood is oxygenated. Normally, a protective membrane keeps this fluid in the vessels. Severe illness or injury, however, can cause damage to the membrane, leading to the fluid leakage of ARDS, he said.

He added that the most common cause of ARDS is sepsis, a serious and widespread infection of the bloodstream. Inhalation of harmful substances and breathing high concentrations of smoke or chemical fumes can result in ARDS, as can inhaling (aspirating) vomit or near-drowning episodes.

Dr. Haroon said severe cases of pneumonia usually affect all five lobes of the lungs and it may trigger ARDS. Head, chest or other major injury, accidents such as falls or car crashes can directly damage the lungs or the portion of the brain that controls breathing, he said.

He added that pancreatitis (inflammation of the pancreas), massive blood transfusions and burns can also cause ARDS. He said early admission to hospital is recommended in patients who have shortness of breath with any infection and all patients with productive cough for over three days should get a chest X-RAY and blood gases. Patients with breathlessness who do not improve on oxygen therapy should be suspected for having ARDS unless proved otherwise, he explained.

Avoid chest infection as much as possible by avoiding cold drinks, cold water, frequent bathing, smoking and also avoid going to public places to avoid catching infection from others, suggested Dr. Haroon.

Always keep gas heaters off when sleeping. Wear warm clothes, socks and cover your exposed body parts as much as possible, he said. He advised that in case of fever, flu or shortness of breath, one should get immediate medical attention and get a chest X-RAY and if no improvement to initial therapy, get blood gases.

He added the patients of ARDS with early diagnosis and treatment respond well usually in long term. Treatment of ARDS is not simple. It needs ICU care with continuous monitoring of heart rate , blood pressure, blood gases, chest findings, intake and output balance, mechanical ventilator support and of course intravenous antibiotics and medicines, explained Dr. Haroon while responding to a query.

The patients with respiratory diseases like asthma , Chronic Obstructive Pulmonary Disease (COPD), allergies and interstitial lung diseases should get vaccinated for influenza and pneumonia and visit their doctors frequently to avoid complications. To a query, he said ARDS treatment has revolutionized over past decade but still we have high mortality in our country because of lack of awareness both in medical and general population.