Department of Medicine, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA 02114, USA.
Semin Respir Crit Care Med. 2013 Aug;34(4):441-7. doi: 10.1055/s-0033-1351162. Epub 2013 Aug 11.
Similar to other syndromes, patients are defined as having acute respiratory distress syndrome (ARDS) when they meet prespecified diagnostic criteria. These criteria have evolved over time, having gained and lost complexity, but the core principles have remained remarkably similar over the past 45 years. The specific diagnostic criteria allow clinicians and investigators to reliably identify patients with the syndrome of ARDS. ARDS is a form of acute diffuse lung injury occurring in patients with a predisposing risk factor. Lung injury is characterized by inflammation leading to increased endothelial and epithelial permeability and loss of aerated lung tissue resulting in hypoxemia and bilateral radiographic opacities on chest radiography. Additional physiological derangements include increased venous admixture and physiological dead space along with decreased respiratory system compliance. The corresponding pathological findings are lung edema, inflammation, hyaline membranes, and alveolar hemorrhage (i.e., diffuse alveolar damage). This article discusses the evolution of the definition of ARDS to the new Berlin definition of ARDS proposed in 2012 and its novel iterative refinement.
类似于其他综合征，当患者符合预先规定的诊断标准时，就被定义为患有急性呼吸窘迫综合征（ARDS）。这些标准随着时间的推移而演变，经历了复杂程度的增减，但在过去的 45 年里，核心原则保持着惊人的相似。特定的诊断标准使临床医生和研究人员能够可靠地识别患有 ARDS 综合征的患者。ARDS 是一种发生在有潜在风险因素的患者中的急性弥漫性肺损伤。肺损伤的特征是炎症导致内皮和上皮通透性增加以及充气肺组织丧失，导致低氧血症和胸部 X 线摄影上的双侧放射性不透明。其他生理紊乱包括静脉混合增加和生理死腔增加，同时呼吸系统顺应性降低。相应的病理发现包括肺水肿、炎症、透明膜和肺泡出血（即弥漫性肺泡损伤）。本文讨论了 ARDS 定义的演变，到 2012 年提出的新柏林 ARDS 定义及其新颖的迭代细化。
