• J Villar, L Pérez-Méndez, and R M Kacmarek.
• Research Institute, Hospital de la Candelaria, Tenerife, Canary Islands, Spain. jvillar@cistia.es
• Intensive Care Med. 1999 Sep 1;25(9):930-5.

BackgroundDespite intensive research, there are no universally accepted clinical definitions for acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS). A recent joint American-European Consensus Conference on ARDS formally defined the difference between ALI and ARDS based on the degree of oxygenation impairment. However, this definition may not reflect the true prevalence, severity and prognosis of these syndromes.MethodsDuring a 22-month period, 56 consecutive mechanically ventilated patients who met the American-European Consensus definition for ARDS [arterial oxygen tension/fractional inspired oxygen (PaO(2)/FIO(2) 150 mmHg with PEEP = 5 cmH(2)O, and ARDS(-24 h) if the PaO(2) /FIO(2) was /= 5 cmH(2)O.ResultsOverall mortality was 43 % (24 of 56). However, 24 h after inclusion, PaO(2) response to PEEP 5 cmH(2)O allowed the separation of our patients into two different groups: 31 patients met our ALI(-24 h) criteria (PaO(2)/FIO(2) > 150 mmHg) and their mortality was 22.6 %; 25 patients met our ARDS(-24 h) criteria (PaO(2)/FIO(2) ConclusionsSince the use of PEEP in the American-European Consensus criteria for ARDS is not mandatory, that definition does not reflect the true severity of lung damage and outcome. Our data support the need for guidelines based on a specific method of evaluating oxygenation status before the American-European Consensus definition is adopted.

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