Department of Anaesthesia and Intensive Care medicine, Galway University Hospitals, Saolta University Hospital Group, Galway, Ireland.
School of Medicine, National University of Ireland, Galway, Ireland.
Semin Respir Crit Care Med. 2022 Jun;43(3):379-389. doi: 10.1055/s-0042-1744306. Epub 2022 Jun 9.
The definition of acute respiratory distress syndrome (ARDS), has evolved since it was first described in 1967 by Ashbaugh and Petty to the current "Berlin" definition of ARDS developed in 2012 by an expert panel, that provided clarification on the definition of "acute," and on the cardiac failure criteria. It expanded the definition to include patients receiving non-invasive ventilation, and removed the term "acute lung injury" and added a requirement of patients to be receiving a minimum 5 cmHO expiratory pressure.Since 2012, a series of observational cohort studies have generated insights into the utility and robustness of this definition. This review will examine novel insights into the epidemiology of ARDS, failures in ARDS diagnosis, the role of lung imaging in ARDS, the novel ARDS cohort that is not invasively ventilated, lung compliance profiles in patients with ARDS, sex differences that exist in ARDS management and outcomes, the progression of ARDS following initial diagnosis, and the clinical profile and outcomes of confirmed versus resolved ARDS. Furthermore, we will discuss studies that challenge the utility of distinguishing ARDS from other causes of acute hypoxemic respiratory failure (AHRF) and identify issues that may need to be addressed in a revised definition.
急性呼吸窘迫综合征 (ARDS) 的定义自 1967 年 Ashbaugh 和 Petty 首次描述以来不断演变，目前采用的是 2012 年由专家小组制定的“柏林”定义，该定义对“急性”和心力衰竭标准的定义进行了澄清。它将定义扩展到包括接受无创通气的患者，并删除了“急性肺损伤”一词，并增加了患者需要接受至少 5cmH2O 呼气压力的要求。自 2012 年以来，一系列观察性队列研究深入了解了这一定义的实用性和稳健性。这篇综述将探讨 ARDS 流行病学、ARDS 诊断失败、肺部影像学在 ARDS 中的作用、未接受有创通气的新型 ARDS 队列、ARDS 患者肺顺应性特征、ARDS 管理和结局中的性别差异、初始诊断后 ARDS 的进展以及确诊和缓解 ARDS 的临床特征和结局等方面的新见解。此外，我们将讨论一些挑战 ARDS 与其他急性低氧性呼吸衰竭 (AHRF) 病因鉴别的研究，并确定在修订定义中可能需要解决的问题。
