The definition of ARDS revisited: 20 years later

Excerpt

More than 20 years ago we set out to create a definition for the acute respiratory distress syndrome (ARDS) in order to standardize clinical and research communication regarding ARDS. Ashbaugh and Petty had described most of the important clinical features of ARDS in 1967, which included hypoxemia, bilateral pulmonary infiltrates, decreased lung compliance, and microscopic evidence of diffuse alveolar damage, but they did not offer specific criteria of the type that could readily be used to define the disorder for clinical, epidemiology, and research purposes [1]. Under the auspices of the American Thoracic Society and the European Society of Intensive Care Medicine we co-chaired the American European Consensus Conference (AECC) on ARDS; this committee met formally in Miami on 15 May 1992 and concluded its work on 26 October 1992 in Barcelona. Membership on the committee included scientists from around the world [2‐4]. The AECC recommended that patients be defined as having acute lung injury (ALI) if, in the context of a risk factor for ARDS, they had recent onset of hypoxemia (P/F ≤ 300 mmHg regardless of use of PEEP) and a chest radiograph consistent with bilateral pulmonary edema. Those with a P/F ratio ≤200 mmHg were defined as ARDS. In both cases, patients were excluded if they had evidence of left atrial hypertension or a pulmonary artery wedge pressure of >18 mmHg that explained the pulmonary edema. …