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Report of the American-European consensus conference on ARDS

Definitions, mechanisms, relevant outcomes and clinical trial coordination

Subcommittee I: definitions

Background and controversies
The subcommittee appointed with defining ARDS had perhaps the most difficult task and ist recommendations were met with the greatest discussion by the parent committee. Some participants suggested that ARDS be defined differently for the purposes of reserch, epidemiology, and individual patient care; ultimately, however, it was decided that one definiton should apply for all of these areas.

Early on it was decided that there should be a return to the original term acute (rather than adult) respiratory distress syndrome in recognition of the fact that ARDS is not limited to adults. In this report, 1 of the 12 patients reported was 11 years old. Confusion over the term can te traced to an article appearing in 1971 in which "adult" was used as part of the term. This creeping of "adult" into the term in now regretted by at least one of the authors (T.L.P., personal communication). Second, it was recognized that the clinical spectrum of presentation included a continuum of arterial blood gas and chest radiograph abnormalities and that the cut-off point for any definition of ARDS would be arbitrary. It was agreed, however, that the term acute lung injury (ALI) could be applied to a wide spectrum of this continuum of pathological process so as to acknowledge and define it. It was felt that the term ARDS should be reserved for the most servere end of this spectrum. Thus all patients with ARDS have acute lung injury but not all patients with acute lung injury have ARDS.

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