Is the term ALI is really obsolete after emergence of the new Berlin definition of ARDS ? Whats is the actual purpose of such a definition?
Hello, I still teach both definitions, mainly because the releveant literature still includes refernces to the definition ALI. The purpose as I see it is to communicate how "sick" the lungs are when including the patient in a research study. There are small differences in prognosis for the three levels of ARDS, but that is evident when looking at a single individual. I also feel the removal of the term Acute from the ARDS picture clarifies the classification of a patient who slowly progresses to mild ARDS or one whose ARDS resolves and then recurs.
Good point, I think there will be some time before the term ALI is obsolete because it is present in the literature, books and the mind of many of us, but eventually it will be obsolete, just like the old name ( adult respiratory distress syndrome).
I think the current terminology is more logic because you are talking about same disease with same characteristics and you can classify it as mild moderate severe.
I've recently read a great Editorial in British Journal of Anaesthesia. See Frohlich S et al (2013), BJA 111(5), 696-9. ARDS: progress unlikely with non-biological definition.
It certainly got me thinking!
We still use the term ALI in our discussion with our team, to focus further on its prevention.
Sorry!....but the term ARDS or RDS is too generic and as such, not accurate. That term has been a nail in my mind all along! Bacterial pneumonia can give respiratory distress, usually distress not that acute - true - but what does distress mean? It means nothing! Dyspnoea is a landmark of all lung inflammations and infections! Besides, if the distress is caused by inflammation as the post-traumatic lung injury former known as ARDS, or is caused by a virus - notoriously influenza or sars ones - is exactly the same type of damage, notwithstanding all the other implications of the virus dynamics. I have always used the term ALI, closer to describe the situation referred to than the generic and useless ARDS. Any term in medicine, and in any other field I suppose, should be the maximal up-most synthesis of the definition of the concept or fact or situation or quality or subject we want to describe. This is valid also for classifications. The best way to describe this kind of lung injury is by either specifying the etiology, if already known, or by using the anatomical 'analysis lens'. Bacterial pneumonia is mainly an intra-alveolar inflammation/infection, whereas what was meant for ARDS is a mainly interstitial disease, whether caused by the inflammatory response to trauma or the local response to a virus. Finally, the two conditions are relatively easy to distinguish clinically. The intra-alveolar bacterial, or the aspiration pneumonia at initial stages - eventually becomes interstitial and the patient is in trouble! -, give 'creps and ronchi' of different intensity often irregularly distributed, moving, and changing intensity after cough, a general picture of sepsis at the onset, and often with increased FVT and percussion note, whereas the interstitial ones are characterized by a normal or almost normal lung on examination with no hints to pathology, in contrast with a co-present clear, sometimes dramatic, respiratory distress, and do not show general sepsis features in the initial stages. Indeed clinical examination can deceive, especially at the initial stages of both pathologies, nevertheless, a clinical dg can be made in many cases on impact with the pt, allowing a preliminary definition then confirmed or excluded by imaging.
- Badges
- Science topic
- Similar topics
- Medicine
- Disease
- Infectious Diseases