Diagnostic criteria for adult respiratory distress syndrome: time for reappraisal.
To assess whether current diagnostic criteria for the adult respiratory distress syndrome (ARDS) may limit research to patients with a range of severity of respiratory failure and risk factors for ARDS were studied. In 28 patients ARDS did not develop; in 9 it did; and the other 13 met the diagnostic criteria at their first assessment. Plasma concentration of neutrophil elastase-alpha 1-antitrypsin complex was higher in all groups than in controls. For all patients, plasma elastase-complex was related to worsening hypoxia and to increased bronchoalveolar lavage protein content. Elastase-complex was present in all bronchoalveolar lavage samples and was related to protein content and differential neutrophil counts. Patients at risk of or with ARDS had a spectrum of respiratory failure to which intravascular and intra-alveolar neutrophil elastase release and capillary permeability were related. This suggests that the state recognised as ARDS is not a distinct pathophysiological entity.
Rocker
G M
GM
Respiratory Medicine Unit, University of Nottingham.
Wiseman
M S
MS
Pearson
D
D
Shale
D J
DJ
D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000201:enzymology / Q000473:pathology; D002199:Capillary Permeability / Q000187:drug effects; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D019272:Leukocyte Elastase; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000201:enzymology*; D010196:Pancreatic Elastase / Q000032:analysis* / Q000097:blood; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000175:diagnosis* / Q000201:enzymology; D012307:Risk Factors; D012720:Severity of Illness Index; D000515:alpha 1-Antitrypsin / Q000032:analysis
D000515:alpha 1-Antitrypsin; C037741:alpha 1-antitrypsin-leukocyte elastase complex; D010196:Pancreatic Elastase; D019272:Leukocyte Elastase