Old and New Definitions of Acute Respiratory Distress Syndrome (ARDS): An Overview of Practical Considerations and Clinical Implications
Lower respiratory tract infections remain a leading cause of morbidity and mortality among Intensive Care Unit patients, with severe cases often progressing to acute respiratory distress syndrome (ARDS). This life-threatening syndrome results from alveolar–capillary membrane injury, causing refracto...
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MDPI AG
2025-07-01
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| author | Cesare Biuzzi Elena Modica Noemi De Filippis Daria Pizzirani Benedetta Galgani Agnese Di Chiaro Daniele Marianello Federico Franchi Fabio Silvio Taccone Sabino Scolletta |
| author_facet | Cesare Biuzzi Elena Modica Noemi De Filippis Daria Pizzirani Benedetta Galgani Agnese Di Chiaro Daniele Marianello Federico Franchi Fabio Silvio Taccone Sabino Scolletta |
| author_sort | Cesare Biuzzi |
| collection | DOAJ |
| description | Lower respiratory tract infections remain a leading cause of morbidity and mortality among Intensive Care Unit patients, with severe cases often progressing to acute respiratory distress syndrome (ARDS). This life-threatening syndrome results from alveolar–capillary membrane injury, causing refractory hypoxemia and respiratory failure. Early detection and management are critical to treat the underlying cause, provide protective lung ventilation, and, eventually, improve patient outcomes. The 2012 Berlin definition standardized ARDS diagnosis but excluded patients on non-invasive ventilation (NIV) or high-flow nasal cannula (HFNC) modalities, which are increasingly used, especially after the COVID-19 pandemic. By excluding these patients, diagnostic delays can occur, risking the progression of lung injury despite ongoing support. Indeed, sustained, vigorous respiratory efforts under non-invasive modalities carry significant potential for patient self-inflicted lung injury (P-SILI), underscoring the need to broaden diagnostic criteria to encompass these increasingly common therapies. Recent proposals expand ARDS criteria to include NIV and HFNCs, lung ultrasound, and the SpO<sub>2</sub>/FiO<sub>2</sub> ratio adaptations designed to improve diagnosis in resource-limited settings lacking arterial blood gases or advanced imaging. However, broader criteria risk overdiagnosis and create challenges in distinguishing ARDS from other causes of acute hypoxemic failure. Furthermore, inter-observer variability in imaging interpretation and inconsistencies in oxygenation assessment, particularly when relying on non-invasive measurements, may compromise diagnostic reliability. To overcome these limitations, a more nuanced diagnostic framework is needed—one that incorporates individualized therapeutic strategies, emphasizes lung-protective ventilation, and integrates advanced physiological or biomarker-based indicators like IL-6, IL-8, and IFN-γ, which are associated with worse outcomes. Such an approach has the potential to improve patient stratification, enable more targeted interventions, and ultimately support the design and conduct of more effective interventional studies. |
| format | Article |
| id | doaj-art-8262069f39a34c9a8e16f5da5c8e2175 |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-8262069f39a34c9a8e16f5da5c8e21752025-08-20T04:00:50ZengMDPI AGDiagnostics2075-44182025-07-011515193010.3390/diagnostics15151930Old and New Definitions of Acute Respiratory Distress Syndrome (ARDS): An Overview of Practical Considerations and Clinical ImplicationsCesare Biuzzi0Elena Modica1Noemi De Filippis2Daria Pizzirani3Benedetta Galgani4Agnese Di Chiaro5Daniele Marianello6Federico Franchi7Fabio Silvio Taccone8Sabino Scolletta9Department of Medical Science, Surgery and Neurosciences, Urgency-Emergency Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, ItalyDepartment of Medical Science, Surgery and Neurosciences, Urgency-Emergency Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, ItalyDepartment of Medical Science, Surgery and Neurosciences, Urgency-Emergency Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, ItalyDepartment of Medical Science, Surgery and Neurosciences, Urgency-Emergency Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, ItalyDepartment of Medical Science, Surgery and Neurosciences, Urgency-Emergency Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, ItalyDepartment of Medical Science, Surgery and Neurosciences, Urgency-Emergency Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, ItalyDepartment of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, ItalyDepartment of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, ItalyDepartment of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), 1070 Brussels, BelgiumDepartment of Medical Science, Surgery and Neurosciences, Urgency-Emergency Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, ItalyLower respiratory tract infections remain a leading cause of morbidity and mortality among Intensive Care Unit patients, with severe cases often progressing to acute respiratory distress syndrome (ARDS). This life-threatening syndrome results from alveolar–capillary membrane injury, causing refractory hypoxemia and respiratory failure. Early detection and management are critical to treat the underlying cause, provide protective lung ventilation, and, eventually, improve patient outcomes. The 2012 Berlin definition standardized ARDS diagnosis but excluded patients on non-invasive ventilation (NIV) or high-flow nasal cannula (HFNC) modalities, which are increasingly used, especially after the COVID-19 pandemic. By excluding these patients, diagnostic delays can occur, risking the progression of lung injury despite ongoing support. Indeed, sustained, vigorous respiratory efforts under non-invasive modalities carry significant potential for patient self-inflicted lung injury (P-SILI), underscoring the need to broaden diagnostic criteria to encompass these increasingly common therapies. Recent proposals expand ARDS criteria to include NIV and HFNCs, lung ultrasound, and the SpO<sub>2</sub>/FiO<sub>2</sub> ratio adaptations designed to improve diagnosis in resource-limited settings lacking arterial blood gases or advanced imaging. However, broader criteria risk overdiagnosis and create challenges in distinguishing ARDS from other causes of acute hypoxemic failure. Furthermore, inter-observer variability in imaging interpretation and inconsistencies in oxygenation assessment, particularly when relying on non-invasive measurements, may compromise diagnostic reliability. To overcome these limitations, a more nuanced diagnostic framework is needed—one that incorporates individualized therapeutic strategies, emphasizes lung-protective ventilation, and integrates advanced physiological or biomarker-based indicators like IL-6, IL-8, and IFN-γ, which are associated with worse outcomes. Such an approach has the potential to improve patient stratification, enable more targeted interventions, and ultimately support the design and conduct of more effective interventional studies.https://www.mdpi.com/2075-4418/15/15/1930ARDSinvasive and non-invasive mechanical ventilationhigh-flow nasal cannula (HFNC)pneumonia |
| spellingShingle | Cesare Biuzzi Elena Modica Noemi De Filippis Daria Pizzirani Benedetta Galgani Agnese Di Chiaro Daniele Marianello Federico Franchi Fabio Silvio Taccone Sabino Scolletta Old and New Definitions of Acute Respiratory Distress Syndrome (ARDS): An Overview of Practical Considerations and Clinical Implications Diagnostics ARDS invasive and non-invasive mechanical ventilation high-flow nasal cannula (HFNC) pneumonia |
| title | Old and New Definitions of Acute Respiratory Distress Syndrome (ARDS): An Overview of Practical Considerations and Clinical Implications |
| title_full | Old and New Definitions of Acute Respiratory Distress Syndrome (ARDS): An Overview of Practical Considerations and Clinical Implications |
| title_fullStr | Old and New Definitions of Acute Respiratory Distress Syndrome (ARDS): An Overview of Practical Considerations and Clinical Implications |
| title_full_unstemmed | Old and New Definitions of Acute Respiratory Distress Syndrome (ARDS): An Overview of Practical Considerations and Clinical Implications |
| title_short | Old and New Definitions of Acute Respiratory Distress Syndrome (ARDS): An Overview of Practical Considerations and Clinical Implications |
| title_sort | old and new definitions of acute respiratory distress syndrome ards an overview of practical considerations and clinical implications |
| topic | ARDS invasive and non-invasive mechanical ventilation high-flow nasal cannula (HFNC) pneumonia |
| url | https://www.mdpi.com/2075-4418/15/15/1930 |
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