Acute Respiratory Distress Syndrome (ARDS): Definition, Incidence, and Outcome
The definition of ARDS has considerably evolved over the last 50 years and is still challenging. Using the current Berlin definition, more than 10% of the patients admitted in the ICU and more than 20% of the patients under mechanical ventilation meet cli
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Acute Respiratory Distress Syndrome (ARDS): Definition, Incidence, and Outcome Rémi Coudroy, Florence Boissier, and Arnaud W. Thille
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Definition of ARDS
1.1.1 F rom the First Clinical Description to the First Consensus Definition of ARDS In 1967, Ashbaugh and colleagues reported for the first time the clinical and physiological characteristics in 12 patients with sudden respiratory failure that they called “acute respiratory distress syndrome” (ARDS) [1]. None of these patients had past history of cardiac or pulmonary disease, and they rapidly developed acute hypoxemia, stiff lungs, and diffuse bilateral alveolar infiltration on chest X-ray a few days later after a precipitating factor. Their outcome was dramatic as 7 of the 12 patients (58%) died. An autopsy was performed in all deceased patients, and six of them (86%) had a characteristic histological pattern of diffuse alveolar damage including hyaline membranes, edema, cell necrosis, or fibrosis [1]. In 1971, Petty and Ashbaugh described principles of management of ARDS based mainly on mechanical ventilation using high FiO2 and positive end-expiratory pressure (PEEP) [2]. Whereas cyanosis refractory to oxygen was one of the clinical
R. Coudroy, MD • F. Boissier, MD, PhD CHU de Poitiers, Réanimation Médicale, Poitiers, France INSERM CIC 1402 (ALIVE Group), Université de Poitiers, Faculté de Médecine, Poitiers, France A.W. Thille, MD, PhD (*) CHU de Poitiers, Réanimation Médicale, Poitiers, France INSERM CIC 1402 (ALIVE Group), Université de Poitiers, Faculté de Médecine, Poitiers, France Réanimation Médicale, CHU de Poitiers, 2 rue la Milétrie, 86021 Poitiers Cedex, France e-mail: [email protected] © Springer International Publishing Switzerland 2017 D. Chiumello (ed.), Acute Respiratory Distress Syndrome (ARDS), DOI 10.1007/978-3-319-41852-0_1
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criteria for ARDS, the authors did not specify any hypoxemia threshold. Five years later, Bone and colleagues proposed a threshold of hypoxemia below 70 mmHg despite FiO2 of at least 0.5 and PEEP [3]. In 1982, Pepe and colleagues added to the definition the presence of new diffuse bilateral infiltrates on chest X-ray and a pulmonary wedge pressure lower than 18 mmHg, thereby excluding cardiogenic pulmonary edema [4]. In 1988, Murray and colleagues proposed the lung injury score (LIS) as a means of assessing the severity of ARDS according to the PaO2/FiO2 ratio, the PEEP level, respiratory system compliance, and the number of quadrants with infiltration seen on chest X-ray [5]. Since this original description, the definition of ARDS has considerably evolved over the time, but it was not until 1994 that an international American–European Consensus Conference (AECC) laid the foundations for the first clinical definition of ARDS [6]. This consensus conference aimed to bring uniformity to the definition of ARDS for research, epidemiologic studies, and individual patient care [6]. ARDS was consequently defined using the following four criteria: (1) the acute onset of hypoxemia, (2) a PaO2
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