The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination.

Abstract

The acute respiratory distress syndrome (ARDS), a process of nonhydrostatic pulmonary edema and hypoxemia associated with a variety of etiologies, carries a high morbidity, mortality (10 to 90%), and financial cost. The reported annual incidence in the United States is 150,000 cases, but this figure has been challenged, and it may be different in Europe. Part of the reason for these uncertainties are the heterogeneity of diseases underlying ARDS and the lack of uniform definitions for ARDS. Thus, those who wish to know the true incidence and outcome of this clinical syndrome are stymied. The American-European Consensus Committee on ARDS was formed to focus on these issues and on the pathophysiologic mechanisms of the process. It was felt that international coordination between North America and Europe in clinical studies of ARDS was becoming increasingly important in order to address the recent plethora of potential therapeutic agents for the prevention and treatment of ARDS.

Effect of Prone Positioning on Clinical Outcomes in Children With Acute Lung Injury

“…18 Patients were excluded if they were less than 2 weeks of age (newborn physiology), less than 42 weeks post-conceptual age (considered preterm), unable to tolerate a position change (persistent hypotension, cerebral hypertension); had respiratory failure from cardiac disease; had hypoxemia without bilateral infiltrates; had received a bone marrow or lung transplant; were supported on extracorporeal membrane oxygenation; had a nonpulmonary condition that could be exacerbated by the prone position; had participated in other clinical trials within the preceding 30 days; or if there was a decision to limit life support. Randomization was done using a permuted blocks design, stratified by center, with random block sizes.…”

The pathogenesis of lung injury following pulmonary resection

“…It also aimed to establish guidelines for the conduct and co-ordination of clinical trials. It was recommended that acute lung injury (ALI) be formally defined as a syndrome of inflammation and increased permeability, associated with a constellation of clinical, radiological and physiological abnormalities that cannot be explained by, but may coexist with, left atrial or pulmonary capillary hypertension, and that the term ARDS should be reserved for the most severe end of this spectrum [7]. ALI and ARDS are acute in onset and persistent, lasting days to weeks, and are associated with a wide variety of pulmonary and nonpulmonary risk factors.…”

High‐dose steroid therapy for acute respiratory distress syndrome lacking common risk factors: predictors of outcome

“…If the patient was not supported by a mechanical ventilator, the F I O 2 level was calculated as follows: oxygen flow (L/min) × 0.03 + 0.21 10. The common risk factors for ARDS were defined as aspiration, diffuse pulmonary infection, near‐drowning, toxic inhalation, lung contusion, non‐pulmonary sepsis, severe non‐thoracic trauma, pancreatitis, severe burns, non‐cardiogenic shock, drug overdose, hypertransfusion for emergency resuscitation, and cardiopulmonary bypass 1, 2…”

“…The acute respiratory distress syndrome (ARDS) is a life‐threatening inflammatory lung disease with a mortality rate of 40–50% 1, 2. Acute respiratory distress syndrome is defined as acute onset of hypoxemia and bilateral pulmonary infiltrates not attributed to cardiac failure or fluid overload with pulmonary or non‐pulmonary risk factors that trigger lung inflammation 1, 2.…”

“…Acute respiratory distress syndrome is defined as acute onset of hypoxemia and bilateral pulmonary infiltrates not attributed to cardiac failure or fluid overload with pulmonary or non‐pulmonary risk factors that trigger lung inflammation 1, 2. Diffuse alveolar damage (DAD), which is usually resistant to treatment, is the accepted histological hallmark of ARDS 1, 2…”