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Acute respiratory distress syndrome ("ARDS"): no more than a severe acute lung injury?

1993; BMJ; Volume: 307; Issue: 6915 Linguagem: Inglês

10.1136/bmj.307.6915.1335

0959-8138

Rupert Beale, Emily Grover, Mark Smithies, D. Bihari,

Thermal Regulation in Medicine

The term "ARDS" was introduced in 1967, when Ashbaugh et al reported a syndrome ofacute respiratory distress in adults."'They described 12 comparatively young patients, one of whom was a child, who had developed acute respiratory failure which seemed to follow a common course.It was said to have occurred in response to various stimuli, but in fact seven of the patients had suffered multiple trauma.Each case was characterised by severe arterial hypoxaemia refractory to oxygen, reduction in lung compliance, and bilateral diffuse alveolar infiltration in the chest x ray film.The oxygenation defect was partially respon- sive to positive end expiratory pressure but in seven cases seemed to be related to strongly positive fluid balance.Postmortem examination disclosed alveolar atelectasis, widespread inflammatory changes, and hyaline membranes.Four years later, in a second paper, the same authors used the term "adult respiratory distress syndrome."2Hence the confusion about what the A in ARDS stands for was born.Since the original description the diagnostic criteria have been modified to emphasise that the pulmonary oedema which occurs is non-cardiogenic and due to an increase in pulmonary capillary permeability.3A pulmonary artery occlusion pressure of less than 18 mm Hg is required to allow differentiation between the acute respiratory distress syndrome and the pulmonary oedema of acute heart failure and fluid overload.Nevertheless, research has been bedevilled by conflicting and insufficiently precise definitions.More recently, the broader label "acute lung injury" has been introduced to describe the full range (including the less severe forms) of acute respiratory failure associated with the recognised risk factors for the acute respiratory distress syndrome (box 1).