[Diagnosis and significance of ARDS]

Adult respiratory distress syndrome (ARDS) is defined as a syndrome of acute respiratory failure following generalized or localized catastrophic events, without a past history of underlying pulmonary diseases, which is manifested by acute onset of dyspnea, laboured breathing and non-cardiogenic lung edema. This syndrome is also characterized by preceding pulmonary or extrapulmonary insults, an almost normal lung function immediately after the catastrophic events, and acute and progressive hypoxemia, decreased pulmonary compliance with chest radiographs showing bilateral diffuse pulmonary infiltrates, associated with very poor outcome. The diagnostic modalities for obtaining pathognomonic findings indicative of ARDS are not established as yet, hence the only way to diagnose ARDS is to evaluate the pathophysiological status, as mentioned in the definition above, by various laboratory examinations. Although there are many reported modifications, the diagnostic criteria suggested by Petty, et al are still widely used in practice. However, it is unknown whether they are strictly followed or not. Nowadays, the significance of making a diagnosis of ARDS on the basis of the above criteria is questioned by some physicians. To address these questions, the authors reported on an overview of ARDS cases seen at ICU of our institute which is providing acute and emergency care services in Okinawa. In the past 10 years (1979-1988), 4500 patients were admitted to our ICU and 170 of them were diagnosed as either having ARDS or their course in ICU were complicated by ARDS. These cases were retrospectively studied.(ABSTRACT TRUNCATED AT 250 WORDS)