title: Continued under-recognition of acute respiratory distress syndrome after the Berlin definition: what is the solution?
abstract: OBJECTIVE
  Timely recognition of acute respiratory distress syndrome (ARDS) may allow for more prompt management and less exacerbation of lung injury. However, the absence of a diagnostic test for ARDS means that the diagnosis of ARDS requires clinician recognition in what is usually a complicated and evolving illness. We review data concerning the extent of recognition of ARDS in the era of the Berlin definition of ARDS.
  
  
  RESULTS
  ARDS continues to be under-recognized - even in the era of the more recent 'Berlin' definition, and significant delay in its recognition is common. Factors contributing to under-recognition may include the complexity of ARDS biology, low specificity of the consensus (diagnostic) criteria, and concerns about reliable interpretation of the chest radiograph. Understandably, 'external' factors are also at play: ICU occupancy and higher patient to clinician ratio impair recognition of ARDS. Timely recognition of ARDS appears important, as it is associated with the use of higher PEEP, prone positioning and neuromuscular blockade which can lower mortality. Computer-aided decision tools seem diagnostically useful, and together with the integration of reliable biomarkers, may further enhance and speed recognition of this syndrome.
  
  
  CONCLUSIONS
  Significant numbers of patients with ARDS are still unrecognized by clinicians in the era of the Berlin definition of ARDS, with potentially important consequences for patient management and outcome.
authors.affiliation: aDepartments of Anesthesia and Critical Care Medicine, Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science, St Michael's Hospital bDepartments of Anesthesia, Physiology and Interdepartmental Division of Critical Care Medicine University of Toronto cDepartment of Critical Care Medicine, Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Canada dDepartment of Health Science, University of Milan-Bicocca eDepartment of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
authors.forename: John G
authors.initials: JG
authors.lastname: Laffey
authors.forename: Tài
authors.initials: T
authors.lastname: Pham
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bellani
mesh_terms: D055371:Acute Lung Injury / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers; D006801:Humans; D019148:Neuromuscular Blockade / Q000379:methods; D016684:Prone Position; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000209:etiology
chemical_list: D015415:Biomarkers