Year in Review 2012: Acute Lung Injury, Interstitial Lung Diseases, Sleep and Physiology.
The incremental changes made in the definition of ALI/ARDS over the last two decades represent a series of landmark events in the history of the condition. The first description of ARDS (Adult Respiratory Distress Syndrome) established the recognition of this syndrome(1) ; the 1994 AECC (America-European Consensus Conference) definition set the standard for ALI/ARDS clinical trials(2) ; while the new Berlin definition, which has revised the AECC version, is based on 18 years clinical investigation and mechanism exploration, and as a result is a more precise and practical(3) guide for clinical evaluation. The essential components of the new Berlin definition of ARDS are: removal of ALI and division of ARDS into three successive stages (mild, moderate and severe) based on timing, chest imaging, PaO(2) /FiO(2) ratio and level of PEEP applied, with, as previously, exclusion of heart failure or fluid overload. The new definition is based on two large scale databases from 7 medical centers and unifies the understanding of ARDS and establishes a new standard for future clinical trials.