Acute respiratory distress syndrome physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Brian Shaller, M.D. [2] Abiodun Akanmode,M.D.[3]

There are no pathognomonic physical exam findings of ARDS. The most notable physical exam findings include respiratory distress as well as findings indicative of the underlying illness, injury, shock, and end organ damage.

The physical exam findings of a patient with ARDS vary according to the underlying cause and typically develop within 24 to 48 hours of the precipitating illness or injury and progress over the course of 1 to 2 weeks. Common physical findings include:

The presence of the following signs of shock or infection on physical examination are highly suggestive of ARDS:

• Temperature (Temp, T): Hyperpyrexia ≥ 38°C or 100.4°F) or low temperature < 36°C or 96.8°F
• Blood pressure (BP): inappropriately low, with a low mean arterial pressure (MAP)
• Heart rate (HR): rapid (tachycardia > 100 beats/minute), normal, or slow (bradycardia < 60 beats/minute)
• Respiratory rate (RR): Tachypnea > 20 breaths/minute or bradypnea < 12 breaths/minute
• Peripheral capillary oxygen saturation (SpO₂): low (< 90% on ambient air or a fraction of inspired oxygen, (FIO₂) of 21% at sea level)

• Cyanosis due to poor oxygenation
• Pallor due to poor perfusion

• Tachypnea^[1]
• Dyspnea
• Coarse breath sounds, rhonchi, crackles, or decreased breath sounds

• Tachycardia or bradycardia on heart auscultation

• Cyanosis
• Cool extremities or reduced peripheral pulses due to poor perfusion