Revised ARDS definition sets out levels of severity
Goal is to detect most serious cases of deadly lung disease earlier
SAN ANTONIO (May 21, 2012) — An international task force today unveiled a revised definition of acute respiratory distress syndrome (ARDS), a disease first recognized during the Vietnam War in casualties with limb injuries who had trouble breathing.
The new definition includes a distinction between the most serious cases of ARDS and cases that are less advanced, said Antonio Anzueto, M.D., of UT Medicine San Antonio, a pulmonologist who served on the ARDS Definition Task Force. The guidelines are based on evidence from data of more than 4,000 patients with ARDS, including 200 from San Antonio.
The guidelines, called the Berlin Definition, are described in the Journal of the American Medical Association. This paper represents a more vigilant approach to identification and diagnosis of ARDS, which doesn’t necessarily begin in the lungs, Dr. Anzueto said. “This new stratification of severity will make clinicians aware the process is starting and interventions have to be applied almost immediately to prevent the disease from progressing,” he said.
UT Medicine is the clinical practice of the School of Medicine at The University of Texas Science Center San Antonio. Dr. Anzueto, professor of medicine at the Health Science Center and section chief of pulmonary diseases at the South Texas Veterans Health Care System, participated in an ARDS network established by the National Institutes of Health and has studied the disease for 15 years.
Vietnam casualties presented with lungs that were white on X-rays, and an early name for ARDS was “white lung.” As many as 8 in every 10 patients died with the disease. In the 1980s a consensus conference was convened to clinically define ARDS and the research network began. New understandings about managing the disease have cut the mortality rate by more than half.
“We are learning that even though patients are surviving ARDS there are long-term consequences,” Dr. Anzueto said. “Generalized weakness, emotional abnormalities and post-traumatic stress disorder are among these.”
University Hospital, a level one trauma center in San Antonio and teaching hospital of the Health Science Center, is a leading hospital for treatment of the disease. Dr. Anzueto’s group contributed data to the revised definition from patients managed in the South Texas Veterans Health Care System and University Hospital.
“This is evidence-based; it is not our opinion sitting at a table smoking cigars,” Dr. Anzueto said.
ARDS continues to be difficult to treat, he said, in part because conditions such as diabetes, obesity and heart disease are impacting the disease in many patients.
The JAMA article coincides with the panel’s presentation of the Berlin Definition on Wednesday, May 23, at the American Thoracic Society 2012 Conference in San Francisco.
UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center at San Antonio. With more than 700 doctors – all faculty from the School of Medicine – UT Medicine is the largest medical practice in Central and South Texas, with expertise in more than 60 different branches of medicine. Primary care doctors and specialists see patients in private practice at UT Medicine’s flagship clinical home, the Medical Arts & Research Center (MARC), located in the South Texas Medical Center at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and there are clinics and physicians at several local and regional hospitals, including CHRISTUS Santa Rosa, University Hospital and Baptist Medical Center. Call (210) 450-9000 to schedule an appointment, or visit the website at www.UTMedicine.org for a complete listing of clinics and phone numbers.