Acute respiratory distress syndrome definition: do we need a change?

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.