Indeed, ARDS developed as a conceptual analogue of the RDS. Back in the 60s, they found that some adult patients with hypoxic respiratory failure and diffuse chest infiltrates also had decreased surfactant.
The disease model based on loss of surfactant in adults lungs was subsequently tested in surfactants and steroids clinical trials, but the results did not validate the disease model.
Their mistake was lumping patients with the above description regardless of the etiology.
Things get interesting in the middle-late 70s, when the lumping mistake was obvious but the field converted ARDS into a Synthetic Syndrome. Fifty years later, we are stuck in this mistake.
In our book, Dr Lynn and I explain in details the tragedy of contemporary critical care, a specialty built on failed definitions like ARDS and sepsis. And we also explain why a revolution is so necessary and so difficult.
Back to the past. In 1984 we were titrating peep to best compliance and FiO2 no greater than 60%.
So - from the general Pediatrician. Got a question.
The nosology of RDS in neonates was pretty well established by the time I spent my 9 months in the NICU (out of 36 months of training). (1977-1980)
It was due to a lack of surfactant. I’m assuming that’s still the valid etiological mechanism in premies.
I always thought that the concept of ARDS developed as a conceptual analogue of the Neonatal disease - washout of surfactant as a result of xxxxx.
Not so?
Hi Pediatrics
Great question. Thank you.
Indeed, ARDS developed as a conceptual analogue of the RDS. Back in the 60s, they found that some adult patients with hypoxic respiratory failure and diffuse chest infiltrates also had decreased surfactant.
The disease model based on loss of surfactant in adults lungs was subsequently tested in surfactants and steroids clinical trials, but the results did not validate the disease model.
Their mistake was lumping patients with the above description regardless of the etiology.
Things get interesting in the middle-late 70s, when the lumping mistake was obvious but the field converted ARDS into a Synthetic Syndrome. Fifty years later, we are stuck in this mistake.
In our book, Dr Lynn and I explain in details the tragedy of contemporary critical care, a specialty built on failed definitions like ARDS and sepsis. And we also explain why a revolution is so necessary and so difficult.
Here's the American Amazon link
https://a.co/d/5HHXnuK
Be my guess