Which medical intervention would the nurse anticipate will be included in the management of a client with acute respiratory distress syndrome (ARDS)?

• A. Chest tube insertion
• B. Aggressive diuretic therapy
• C. Administration of beta-blockers
• D. Positive end-expiratory pressure (PEEP)

Answer: (D)

Acute respiratory distress syndrome impairs oxygenation because fluid-filled and collapsed alveoli create a large shunt, so keeping the lungs open at the end of exhalation is crucial. Positive end-expiratory pressure, delivered with mechanical ventilation, helps recruit collapsed alveoli and keeps them from closing at the end of each breath. This increases the surface area for gas exchange and improves oxygenation, often allowing lower FiO2 needs and better overall oxygen delivery.

In practice, this is a key part of ARDS management, and the nurse would anticipate seeing PEEP settings on the ventilator. Monitor for effects like improved oxygenation, but also watch for potential downsides such as hypotension from reduced venous return or signs of barotrauma. The other options aren’t the primary ARDS intervention: chest tube is used for pneumothorax or certain effusions, aggressive diuresis isn’t the standard frontline ARDS treatment and can be risky if the patient is hypotensive, and beta-blockers aren’t used to treat ARDS.