Rethinking Acute Respiratory Distress Syndrome after COVID-19: If a Better Definition Is the Answer, What Is the Question?

The definition of acute respiratory distress syndrome (ARDS) has a somewhat controversial history, with some even questioning the need for the term ARDS. This controversy has been amplified by the coronavirus disease (COVID-19) pandemic given the marked increase in the incidence of ARDS, the relatively new treatment modalities that do not fit neatly with the Berlin definition, and the difficulty of making the diagnosis in resource-limited settings. We propose that attempts to revise the definition of ARDS should apply the framework originally developed by psychologists and social scientists and used by other medical disciplines to generate and assess definitions of clinical syndromes that do not have gold standards. This framework is structured around measures of reliability, feasibility, and validity. Future revisions of the definition of ARDS should contain the purpose, the methodology, and the framework for empirically testing any proposed definition. Attempts to revise critical illness syndromes' definitions usually hope to make them better; our recommendation is that future attempts use the same criteria used by other fields in defining what better means.

Automated summary

The definition of acute respiratory distress syndrome (ARDS) has encountered controversies, especially during the COVID-19 pandemic. The increase in ARDS incidence, new treatment modalities, and difficulty of diagnosis in resource-limited settings have further amplified the debates. This article suggests using a framework developed by psychologists and social scientists to revise the definition of ARDS in a structured manner, focusing on measures of reliability, feasibility, and validity.