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Editorials |

Does the Clinical Consensus Definition of ALI/ARDS Continue to Fit Our Needs?

Mark J. Rumbak, MD, FCCP; David A. Solomon, MD, FCCP
Author and Funding Information

Correspondence to: Mark J. Rumbak, MD, FCCP, James A. Haley Veterans Administration Hospital, Professor of Medicine, 13000 Bruce B. Downs Blvd (IIIC), Tampa, FL 33612; e-mail: mrumbak@health.usf.edu

Drs. Rumbak and Solomon are affiliated with the Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of South Florida College of Medicine.


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(2):251-252. doi:10.1378/chest.08-2365
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In this issue of CHEST (see page 261), Quartin et al1 make some important points, which may force the clinical algorithm of acute lung injury (ALI) including ARDS to be changed!2 The investigators found a subgroup of these patients being adequately and safely treated in a non-ICU setting without the need for mechanical ventilation.1 The non-ICU group of ALI/ARDS patients was treated in an isolation ward on the regular medical/surgical floor after only a basic clinical examination, one chest radiograph (CXR), and an arterial blood gas measurement. They also found that the 90-day mortality rate was the same for patients in this subgroup were subsequently admitted to the ICU (even if they were mechanically ventilated) as for those who remained outside the ICU. Similarly, this group had a significantly lower mortality rate than patients with ALI/ARDS who were initially admitted to the ICU whether they were mechanically ventilated or not. The non-ICU ALI/ARDS patients may represent a less severe manifestation of ALI/ARDS or a totally different disease or group of diseases.

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