001). Compared to the AECC definition, the Berlin definition presented better predictive validity for mortality, with an area under the ROC curve (AUROC) of 0.577 (95% CI, 0.561-0.593) versus 0.536 (95% CI, 0.520-0.553, p < 0.001). Moreover, the median number of days free of mechanical ventilation decreased significantly when comparing mild, moderate, and severe

ARDS. 50 Obviously, studies aimed to establish diagnostic and definition criteria for a given disease are not free of difficulties that are inherent to the biological area. Thus, the definition shown here has limitations explained by the authors,50 namely: 1) The capacity of the Berlin definition was statistically superior when compared to the definition of AECC; however, the difference

learn more was small and would not have clinical significance if the Berlin definition had been designed only as a clinical prediction tool, which did not occur. The importance of announcing a new definition of ARDS for pediatric intensivists/emergency physicians/neonatologists is justified in itself. That is, from the experience of applying other definitions, and, consequently of their improvement, the new definition discloses selleck chemical another method to diagnose, stratify the severity, apply therapeutic strategies, and more accurately establish the prognosis of a from disease as serious as ARDS. As the Berlin consensus was initially presented at a congress that did not necessarily include pediatricians, the need for a wider dissemination of this new definition to the pediatric intensive care area is obvious. The definition of the Berlin consensus has

important differences when compared to the definitions published to date, a characteristic that promptly results in practical aspects, including: 1) The condition previously called “acute lung injury”, considered a minor and not clinically significant condition, was excluded and reclassified as mild ARDS. The study that applied the Berlin consensus50 showed an alarming fact: almost a quarter of patients, considering the previous definition, were diagnosed as ALI and not as mild ARDS (PaO2/FiO2 between 200 and 300 mmHg). It is noteworthy that the mortality in patients with mild ARDS was 27%. Certainly, patients at this stage of disease severity should be treated promptly, following established protocols of noninvasive mechanical ventilation and lung-protective invasive mechanical ventilation with PEEP, and deserve attention from the health teams regarding monitoring and stricter therapeutic clinical intervention. It is also noteworthy that patients with PaO2/FiO2 between 200 and 300 mmHg had no established diagnosis of ARDS or ALI; ARDS is a serious disease that constitutes an ongoing diagnostic and therapeutic challenge.