What do we treat when we treat ARDS?

Excerpt

Treating individual patients is a physician’s primary responsibility. To do this well, the physician must identify—as far as possible—what is the patient’s diagnosis, and, over time, be able to understand and apply the results of evolving research. Identifying patients with ARDS dates from Ashbaugh’s report of 12 patients in 1967 (acute onset of tachypnea, hypoxemia, and loss of compliance) [1], and the initial definition of ARDS (adult respiratory distress syndrome) by Petty in 1971 [2]. The first quantitative definition, the Lung Injury Score, by Murray in 1988 assigned values to radiographic infiltrates, oxygenation, PEEP, and respiratory system compliance [3]. Twenty-five years later, the American-European Consensus Conference (AECC) re-defined ARDS, emphasizing acute onset, hypoxemia, bilateral infiltrates on chest radiograph, and the absence of heart failure [4], and this binary definition was the basis for trial entry for the next two decades. In 2012, the Berlin definition of ARDS was proposed. No definitions, however, incorporated mechanisms of injury. …