Acute respiratory distress syndrome definition: do we need... : Current Opinion in Critical Care (original) (raw)

Respiratory system: Edited by Antonio Pesenti

aCIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid

bMultidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr Negrin, Las Palmas de Gran Canaria, Spain

cKeenan Research Center at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada

dIntensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain

eDepartment of Respiratory Care, Massachusetts General Hospital, USA

fDepartment of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Dr Jesús Villar, Multidisciplinary Organ Dysfunction Evaluation Research Network, Hospital Universitario Dr Negrin, Barranco de la Ballena, s/n - 4th floor, South wing, 35010 Las Palmas de Gran Canaria, Canary Islands, Spain Tel: +34 928 449413; fax: +34 928 449813; e-mail: [email protected]

Abstract

Purpose of review

Since the first description of the acute respiratory distress syndrome (ARDS) in 1967, no specific clinical sign or diagnostic test has yet been described that identifies ARDS. Its diagnosis is based on a combination of clinical, hemodynamic, and oxygenation criteria. The purpose of this review is to examine the current definition for ARDS and to discuss why this definition may not be the most appropriate definition for this syndrome.

Recent findings

We will briefly review our current understanding of ARDS, discuss the problems with its current diagnosis, and present clinical, pathological, and biochemical evidences supporting a more appropriate definition for ARDS. In addition, we will discuss recent efforts to identify biological markers for lung injury in pulmonary edema fluid and blood collected from critically ill patients.

Summary

On the basis of current evidence, it is time for a change in the ARDS definition. A newer classification system that recognizes different severities of pulmonary dysfunction is needed. Such a system should be able to identify patients that would be most responsive to supportive therapies and those unlikely to benefit because of the severity of their disease.