title: Acute Respiratory Distress: from syndrome to disease.
abstract: The acute respiratory distress syndrome (ARDS) is currently one of the most important critical entities given its high incidence, rate of mortality, long-term sequelae and non-specific pharmacological treatment. The histological hallmark of ARDS is diffuse alveolar damage (DAD). Approximately 50% of ARDS patients present DAD, the rest is made up of a heterogeneous group of histological patterns, many of which correspond to a well-recognized disease. For that reason, if these patterns could be diagnosed, patients could benefit from a treatment. Recently, the effect of DAD in clinical and analytical evolution of ARDS has been demonstrated, so the classical approach to ARDS as an entity defined solely by clinical, radiological and gasometrical variables should be reconsidered. This narrative review aims to examine the need to evolve from the concept of ARDS as a syndrome to ARDS as a specific disease. So we have raised 4 critical questions: a) What is a disease?; b) what is DAD?; c) how is DAD considered according to ARDS definition?, and d) what is the relationship between ARDS and DAD?
authors.affiliation: Servicio de Emergencia, Hospital Universitario HM Sanchinarro, Madrid, España. Electronic address: pablocardinal@hotmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Cardinal-Fernández
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Español de Buenos Aires, Buenos Aires, Argentina.
authors.forename: E
authors.initials: E
authors.lastname: Correger
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Universitario HM Sanchinarro, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Villanueva
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Nacional Profesor Alejando Posadas, Buenos Aires, Argentina.
authors.forename: F
authors.initials: F
authors.lastname: Rios
mesh_terms: D006801:Humans; D011650:Pulmonary Alveoli / Q000473:pathology*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000628:therapy
keywords: ARDS; Berlin definition; Daño alveolar difuso; Definición de Berlín; Diffuse alveolar damage; Disease; Enfermedad; Histologia; Histology; SDRA; Sindrome; Syndrome