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Published ahead of print on July 14, 2005, doi:10.1164/rccm.200504-663OE

Am. J. Respir. Crit. Care Med., Volume 172, Number 7, October 2005, 798-806

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Submitted on April 27, 2005
Accepted on July 14, 2005

Acute Respiratory Distress Syndrome: A Historical Perspective

Gordon R Bernard1*

1 Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN, United States

* To whom correspondence should be addressed. E-mail: gordon.bernard{at}vanderbilt.edu.

Though well described even in ancient writings, the Acute Respiratory Distress Syndrome (ARDS) gained major medical attention with the availability of mechanical ventilation and establishment of intensive care units. In the fifty years since this beginning there have been remarkable advances in the understanding of the etiology, physiology, histology and epidemiology of this often lethal complication of common human maladies. Until recently, improvements in outcome have mainly followed improvements in intensive care unit operation and their associated life support systems and not through discoveries made in the course of prospective randomized trials. In spite of the remarkable increase in research focused on ARDS, there remain a large number of unanswered clinical questions that are potentially extremely important with regard to short term morbidity as well as long term outcome. The ARDS Clinical Trials Network study of tidal volume has proven that randomized trials in ARDS with positive results are possible even when using difficult primary outcome measures such as mortality or ventilator free days. Therefore the rich combination of new trial strategies, potential treatments, experienced investigators and increasingly standardized routine care, set the stage for rapid advances to be made in the short and long-term outcomes of this devastating syndrome.
Key words: ARDS, Acute lung injury, non-cardiogenic pulmonary edema, Acute respiratory distress syndrome, Adult respiratory distress syndrome, acute lung injury




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