Table 1 Evolution of ALI/DADS definition
From: Acute Respiratory Distress Syndrome in Cancer Patients
Ashbaugh | American-European Consensus Conference (AECC) | Berlin | |
|---|---|---|---|
Year | 1967 | 1994 | 2012 |
ARDS description | Rapidly progressive respiratory failure associated with noncardiogenic pulmonary edema (permeability pulmonary edema) and severe hypoxemia; PCW < 18 mm Hg or no clinical evidence of left atrial hypertension | Rapidly progressive respiratory failure associated with noncardiogenic pulmonary edema (permeability pulmonary edema) and severe hypoxemia; PCW measurements not required; hydrostatic edema excluded via other clinical clues | Rapidly progressive respiratory failure not explained by cardiac failure or volume overload and occurring within 1 week of the triggering event |
Definition of “Acute” | “Acute” without further definition | “Acute” without further definition | Onset within 1 week of a known clinical insult or new or worsening respiratory symptoms |
ARDS stratification | None specified | Any patient with PaO2/FIO2 <200 | Three mutually exclusive subgroups identified based on PaO2/FIO2 and PEEP >5 mm Hg |
Mild: 200 mmHg>PaO2/FIO2<300 mmHg | |||
Moderate: 100 mmHgPaO2/FIO2<200 mmHg | |||
Severe: PaO2/FIO2<100 mmHg | |||
Oxygen/PEEP specifications | None specified, other than hypoxemia requiring oxygenation | Arterial partial pressure of oxygen to fraction of inspired oxygen PaO2/FIO2 <200 mm Hg), regardless of PEEP | Stratified according to PEEP or CPAP requirements: mild, PEEP or CPAP <5 mmHg; moderate or severe, PEEP >5 cm H2O |
Risk factors | None specified | None specified | Pneumonia, sepsis, trauma pancreatitis; echocardiography recommended to exclude hydrostatic edema if no risk factor identified |
ALI designation | ALI not recognized | Same as ARDS except PaO2/FIO2<300 mm Hg | ALI category removed from definition |