The Acute Respiratory Distress Syndrome Network

The diagnosis of adult respiratory distress syndrome, even now with the new Berlin definition, is sensitive but not specific for finding diffuse alveolar damage on pathology. The definition is limited by the very poor information obtained using chest radiographs; PET scans can discern whether inflammation is present, which would distinguish fluid and atelectasis from infection or an inflammatory state. Nonetheless, the treatment of patients who meet the Berlin definition should include lung protective ventilation, which involves the use of low tidal volumes (6mL/kg of predicted body weight as determined by height). Furthermore, a plateau pressure of less than 30 should be achieved with the tidal volume, or the tidal volume needs to be lowered or a rescue therapy needs to be utilized. The timing of rescue therapy, the best rescue therapy, and the methods for determining PEEP are still being investigated.

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