This editorial introduces a four-part series on acute respiratory distress syndrome (ARDS) that will cover a wide range of related topics in reviews written by internationally renowned experts. The first part of this series will be published in this issue of the European Respiratory Review by Guérin [1] on the role of prone positioning. This will be followed by articles on the topics of: 1) the role of imaging in the diagnosis and management of ARDS; 2) the novel ventilatory aspects involved in managing patients with ARDS; and 3) how to manage a patient failing conventional ventilation with extracorporeal support, in particular, extracorporeal membrane oxygenation (ECMO).
It is nearly 50 years since the first report of “acute respiratory distress in adults” by Ashbaugh et al. [2]. This later became known as ARDS and acute lung injury (ALI). This group of conditions was characterised by acute onset of hypoxaemia associated with the presence of bilateral infiltrates on chest radiography, poor lung compliance and the exclusion of cardiogenic pulmonary oedema [3]. ARDS may develop after a diverse spectrum of causes. These associated conditions may be categorised according to the nature of the insult with, for example, pulmonary sepsis causing a “direct” insult whilst pancreatitis and non-pulmonary sepsis cause an “indirect” insult resulting in ARDS often as part of multi-organ dysfunction syndrome. Despite some evidence of improvements in mortality in selected centres over recent decades, ARDS remains a major public health problem with a 28-day mortality in the region of 25–35%, and a corresponding large fiscal burden to national health services [4].
In 1994, an American–European Consensus Conference (AECC) formalised the criteria for the diagnosis of ARDS and ALI. Thus, ARDS was defined by an arterial oxygen tension (PaO2)/inspiratory oxygen fraction …
