Point of viewThe American-European Consensus Conference definition of the acute respiratory distress syndrome is dead, long live positive end-expiratory pressure!La definición del síndrome de distrés respiratorio agudo según la Conferencia de Consenso Americana-Europea está muerta, ¡larga vida a la presión positiva espiratoria final!
Section snippets
Introduction and historical remarks
In August 1967, Ashbaugh et al.9 described for the first time a syndrome that they termed the ARDS. They studied a cohort of 272 patients who were receiving respiratory support, and from this cohort they identified 12 patients with a syndrome that was similar to the Infant Respiratory Distress Syndrome. The respiratory distress was defined as sudden, catastrophic, and often associated with a multiorgan system insult which led to tachypnea, hypoxemia, decreased respiratory system compliance, and
An early PEEP/FiO2 trial identifies different degrees of ARDS severity
In 1999, Villar et al.3 proposed the need for different guidelines, based on a specific, standard method of evaluating oxygenation status, a proposal that was later advocated by others.11 In order to determine the impact of various PEEP and FiO2 levels on the stratification of patients meeting the AECC ARDS definition, Villar et al.5 evaluated the impact of standard ventilation settings applied on the day patients met the AECC ARDS criteria and 24 h later. They studied 170 patients and found
The “Berlin Definition”
A proposal for an update of the AECC ARDS definition has been published recently6 by a task force panel of experts using a similar terminology as we had previously reported. Using teleconferencing, in-person discussions and retrospective data, they proposed an ARDS classification with three severity categories (mild, moderate, and severe) for empirical evaluation. The term “mild” ARDS was used for defining those patients who are considered as ALI in the AECC definition (300 ≥ PaO2/FiO2 > 200 mmHg).
Funding
Supported by Instituto de Salud Carlos III, Spain (PI 10/0393) and the Asociación Científica Pulmón y Ventilación Mecánica.
Conflict of interest
The authors have no conflict of interest to declare.
References (23)
- et al.
Acute respiratory distress in adults
Lancet
(1967) - et al.
The American-European Consensus Conference on ARDS
Am J Respir Crit Care Med
(1994) - et al.
Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome
Intensive Care Med
(1999) - et al.
A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial
Crit Care Med
(2006) - et al.
An early PEEP/FIO2 trial identifies different degrees of lung injury in patients with acute respiratory distress syndrome
Am J Respir Crit Care Med
(2007) Acute respiratory distress syndrome
JAMA
(2012)- et al.
The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation
Intensive Care Med
(2011) - López-Fernández Y, Martínez-de Azagra A, de la Oliva P, Modesto V, Sánchez JI, Parrilla J, et al. The Pediatric Alien...
What is the acute respiratory distress syndrome?
Respir Care
(2011)
Screening of ARDS patients using standardized ventilator settings: influence on enrollment in a clinical trial
Intensive Care Med
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