Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome

Villar, Jesús; Pérez‐Méndez, Lina; Kacmarek, Robert M.

doi:10.1007/s001340050984

Cited by 166 publications

(112 citation statements)

References 20 publications

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“…1 Recent data suggest that there may be distinct subgroups of ALI/ARDS patients with markedly different responses to higher PEEP. [38][39][40][41][42] Whole-body computed tomography has demonstrated that higher PEEP in patients with a low percentage of recruitable lung (non-responders) provides little benefit and may be harmful. 39 In another study, nonresponders (Ͻ 150 mL alveolar recruitment) who received a higher PEEP protocol similar to that used in one of the studies in our systematic review 15 experienced no change in arterial oxygenation, but did experience significant increases in static lung elastance.…”

Section: Discussionmentioning

confidence: 99%

Higher PEEP in Patients With Acute Lung Injury: A Systematic Review and Meta-Analysis

2011

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BACKGROUND: Studies of ventilation strategies that included higher PEEP in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) have yielded conflicting results. OBJECTIVE: To determine whether higher PEEP during volume-limited and pressure-limited ventilation is associated with 28-day mortality or barotrauma rates in patients with ALI/ARDS. METHODS: We searched MEDLINE, CENTRAL, EMBASE, CINAHL, Web of Science, and the bibliographies of retrieved papers to identify randomized controlled trials that compared higher and lower PEEP in adult patients with ALI/ARDS who were already receiving volume-limited or pressure-limited ventilation. Two of us independently abstracted study-level data, including study design, patient characteristics, study methods, intervention, and main results. We pooled the studylevel data with a random-effects model, unless heterogeneity was low (I 2 < 50%), in which case we used a fixed-effects model. The primary outcome was 28-day mortality. RESULTS: Four randomized trials (2,360 participants) were evaluated. Higher PEEP had a nonsignificant trend toward lower 28-day mortality (pooled relative risk 0.90, 95% CI 0.79 -1.02). There was no difference in barotrauma between the 2 groups (pooled relative risk 1.17, 95% CI 0.90 -1.52). Two studies reported an adjusted hospital death rate, and the pooled results of sensitivity analysis with those adjusted rates were identical to those of the unadjusted analysis. CONCLUSIONS: In 4 recent studies that used volume-limited or pressure-limited ventilation in ALI/ARDS patients, higher PEEP was not associated with significantly different short-term mortality or barotrauma. This study does not support the routine use of higher PEEP in patients with ALI/ARDS.

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Section: Discussionmentioning

confidence: 99%

Higher PEEP in Patients With Acute Lung Injury: A Systematic Review and Meta-Analysis

2011

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“…One of the most frequently studied indices is the Pa,O 2 / FI,O 2 , although contradictory results concerning its ability to predict outcome have been reported in adult AHRF/ARDS [2,[27][28][29][30][31][32][33][34][35]. Some authors have argued that the ratio may not be predictive at inclusion, but after 24 or 48 h [30,31].…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have argued that the ratio may not be predictive at inclusion, but after 24 or 48 h [30,31]. Two paediatric studies on children with generalised AHRF also failed to clearly define respiratory parameters for outcome prediction [6,7].…”

Section: Discussionmentioning

confidence: 99%

Incidence and short-term outcome of acute lung injury in mechanically ventilated children

Dahlem¹,

Aalderen²,

Hamaker³

et al. 2003

Eur Respir J

115

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The aim of this study was to determine the incidence and short-term outcome of mechanically ventilated children suffering from acute lung injury (ALI) on a paediatric intensive care unit (PICU).Between January 1 1998 and January 1 2000, all mechanically ventilated children were evaluated using the criteria of an American-European Consensus Conference.Of the 443 children eligible for analysis, 44 (9.9%) were diagnosed as suffering from ALI. Of these, 79.5% developed the acute respiratory distress syndrome (ARDS); 54.5% (24 of 44) fulfilled the ARDS criteria at inclusion and 25% (11 of 44) later. PICU mortality for ALI was 27.3% (12 of 44) and within the ARDS subgroup 31.4% (11 of 35). Of the 12 children who died, 11 had ARDS; the main cause of death was cerebral damage (seven of 12).Acute lung injury and acute respiratory distress syndrome are rare diseases on apaediatric intensive care unit with a high mortality. Most of the children with acutelung injury develop acute respiratory distress syndrome. In the acute respiratory distress syndrome subgroup, mortality is higher than in the acute lung injury nonacute respiratory distress syndrome subgroup. Further investigations should confirm prognostic factors (e.g.respiratory parameters) for prediction of outcome.

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“…From a therapeutic point of view, we need a rigorous stratification of lung injury severity since the intensity and modality of ventilatory support and adjunctive therapies should differ depending on the degree of hypoxemia. From the research perspective, a precise definition helps to standardize studies on etiology, pathophysiology and treatment [6], improves our ability to compare data among studies and centers, and helps in evaluating the natural history, incidence, and prognosis of ARDS [7].…”

Section: Searching For a Satisfactory Ards Definitionmentioning

confidence: 99%

“…This definition was challenged by Villar et al [7,9,10], when they demonstrated that the PaO 2 response to standardized ventilatory settings (which included a specific level of PEEP and FiO 2 ) allowed the separation of ARDS patients into several groups with different severity and outcome. They observed that: (1) about half of the patients were improperly classified, and (2) ARDS patients could be uniformly stratified according to their response to a PEEP-FiO 2 trial.…”

Section: Searching For a Satisfactory Ards Definitionmentioning

confidence: 99%

The Berlin definition met our needs: no

2016

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Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome

Cited by 166 publications

References 20 publications

Higher PEEP in Patients With Acute Lung Injury: A Systematic Review and Meta-Analysis

Higher PEEP in Patients With Acute Lung Injury: A Systematic Review and Meta-Analysis

Incidence and short-term outcome of acute lung injury in mechanically ventilated children

The Berlin definition met our needs: no

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