![]() Second, the definition did not explicitly define the time interval for “acute.” Third, the level of PEEP utilized during ventilation was not incorporated in the definition. First, the reliability in reading chest radiographs was questionable. Nevertheless, the aforementioned definition also presented several shortcomings. ![]() Since its description, the American and European Consensus Conference definition has been widely used for enrollment of ARDS patients in therapeutic clinical trials ( 11– 15). Therefore, patients with a PaO 2/FiO 2 of 200 to 300 were included within this group. The term ALI was adopted from the lung injury score to include patients with less severe forms of the same pathological entity. There were three diagnostic criteria: 1) PaO 2/FiO 2 ≤ 200, 2) bilateral infiltrates on chest radiograph, and 3) pulmonary artery occlusion pressure < 18 mm Hg when measured by pulmonary artery catheterization, or no clinical evidence of left atrial hypertension. In 1994, the American and European Consensus Conference established specific clinical criteria for ARDS and ALI ( 10). Despite its clinical utility, the score was unable to differentiate between cardiogenic and noncardiogenic edema ( 9). In 1988, Murray et al introduced the lung injury score, which included chest radiograph, the ratio of the partial pressure of arterial oxygen and the fraction of inspired oxygen (PaO 2/FiO 2), total respiratory system compliance, and positive end-expiratory pressure (PEEP). ![]() Since these entities were originally described, multiple definitions or diagnostic criteria have been proposed. ![]() ARDS and what was previously called acute lung injury (ALI) are both characterized by rapid onset of respiratory failure following a variety of direct and indirect lung insults. ![]()
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