title: Time to change diagnostic criteria of ARDS: towards the disease entity-based subgrouping.
abstract: Because of high mortality and morbidity, acute respiratory distress syndrome (ARDS) continues to be one of the clinical challenges for intensivists. The diagnostic criteria for ARDS published by the American-European consensus conference were over simplified and made it possible to conduct large-scale randomized controlled trails (RCTs). Thus, many RCTs have been conducted in attempts to evaluate new treatment modalities, but many have reported negative results, in part because this definition was too broad to be used as diagnostic criteria. Pulmonary ARDS and extrapulmonary ARDS differ in terms of their morbidity and mortality with the presence of organ failure being an important risk factor for mortality in ARDS patients. The Classification of ARDS into several subgroups, which take the underlying disease into account, might limit the number of patients enrolled in an RCT. Where as this subgroup classification would enable selection of a homogeneous population of ARDS patients and may be a key to conducting more focused RCTs and, therefore, having more reliable results.
authors.affiliation: Department of Anesthesiology and Intensive Care, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan. shinhiro@nms.ac.jp
authors.forename: Shinhiro
authors.initials: S
authors.lastname: Takeda
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Ishizaka
authors.forename: Yuji
authors.initials: Y
authors.lastname: Fujino
authors.forename: Toshio
authors.initials: T
authors.lastname: Fukuoka
authors.forename: Osamu
authors.initials: O
authors.lastname: Nagano
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Yamada
authors.forename: Jun
authors.initials: J
authors.lastname: Takezawa
mesh_terms: D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D012720:Severity of Illness Index