Acute respiratory distress syndrome historical perspective

Acute respiratory distress syndrome Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Acute respiratory distress syndrome from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic study of choice
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
Echocardiography
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Mechanical Ventilation Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Acute respiratory distress syndrome historical perspective On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Acute respiratory distress syndrome historical perspective All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Acute respiratory distress syndrome historical perspective
CDC on Acute respiratory distress syndrome historical perspective
Acute respiratory distress syndrome historical perspective in the news
Blogs on Acute respiratory distress syndrome historical perspective
Directions to Hospitals Treating Acute respiratory distress syndrome
Risk calculators and risk factors for Acute respiratory distress syndrome historical perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Brian Shaller, M.D. [2]

Overview

Although the pathologic features of acute respiratory distress syndrome (ARDS) were first documented in the 19th century, the modern definition of ARDS did not arise until the 1960s. In 2012, the Berlin Definition of ARDS became the standard diagnostic criteria and definition of the syndrome.

Historical Perspective

Although the first pathologic description of ARDS dates back to 1821, our understanding of the distinct pathophysiologic features of ARDS evolved alongside the development of medical technologies that facilitated a more in-depth study of the syndrome. The advent of radiography permitted visualization of the bilateral pulmonary infiltrates (originally termed double pneumonia), while the development of arterial blood gas measurement and positive-pressure mechanical ventilation allowed for identification of the impaired oxygenation and reduced lung compliance that are now recognized as central features of ARDS.

In 1967, Ashbaugh and colleagues first described the clinical entity "acute respiratory distress in adults" characterized by a clinical and pathological course of events remarkably similar to the infantile respiratory distress syndrome. In the case series, 12 patients developed severe dyspnea, tachypnea, cyanosis refractory to oxygen therapy, decreased pulmonary compliance, and diffuse alveolar infiltration following trauma, viral infection, or acute pancreatitis. Autopsy findings of the lungs include atelectasis, vascular congestion, hemorrhage, pulmonary edema, and hyaline membranes.

Until the formulation of the Berlin Definition of ARDS, the most widely adopted definition was devised by the American European Consensus Conference (AECC) in 1994. The AECC committee defined acute lung injury (ALI) as "a syndrome of inflammation and increased permeability that is associated with a constellation of clinical, radiologic, and physiologic abnormalities that cannot be explained by, but may coexist with, left atrial or pulmonary capillary hypertension" and "is associated most often with sepsis syndrome, aspiration, primary pneumonia, or multiple trauma". The term ARDS was reserved for the end of this spectrum with the most severe oxygenation deficit. ALI and ARDS are acute in onset and persistent, are associated with one or more known risk factors, and are characterized by arterial hypoxemia resistant to oxygen therapy alone and diffuse radiologic infiltrates.

The AECC definition was superseded by the Berlin Definition from the ARDS Definition Task Force in 2012. The major changes to the Berlin Definition of ARDS include: the term ALI was removed, pulmonary artery wedge pressure requirement was removed, subgroups by severity of oxygenation deficit were added, and minimal PEEP or CPAP levels across subgroups were added. According to the Berlin Definition, what was once ALI is now classified as mild ARDS.