Acute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy study

Abstract

The presence of DAD appears to define a specific subphenotype in patients with ARDS. Targeting patients with DAD within the population of patients with the clinical diagnosis of ARDS might be appropriate to find effective therapies for this condition.

Imaging of Acute Lung Injury

“…16 Although most patients who die with ARDS succumb to multiorgan failure or shock, the presence of DAD on histopathology was associated with a higher risk of death from respiratory failure. 17 Among patients with DAD, mortality may also vary depending on the clinical context. For example, the mortality of patients with DAD due to an acute exacerbation of IPF is as high as 86%.…”

The Berlin definition met our needs: not sure

“…The main reason for this lack of success is the heterogeneity of the syndrome, even at the pathology level. Autopsy [7,8] and biopsy [9,10] studies have revealed that only about 50 % of ARDS patients have the typical diffuse alveolar damage (DAD) pattern. The presence of DAD was associated with more severe disease and a greater likelihood of death associated with hypoxemia [8].…”

Do we need ARDS?

“…Autopsy studies have revealed that many patients do not have the typical diffuse alveolar damage (DAD) pattern; in our experience, only 50 % of patients with a clinical diagnosis of ARDS who underwent autopsy had DAD [3]. In a very recent autopsy study, Lorente et al [4] reported that DAD was associated with greater degrees of respiratory and general disease severity, and with a greater likelihood of death from shock. Kao et al [5] reported that only 56 % of 101 patients with a clinical diagnosis of ARDS who underwent open lung biopsy had DAD; a pathological finding of DAD was associated with increased hospital mortality in these patients.…”