Table 2 Potential recommendations for improving the definition of ARDS

New datasets

1. Expiration date for observational studies and trials conducted before year 2010

Actionable criteria

2. Definition should be based on actionable and modifiable criteria, including VD/VT, lung imaging, biomarker levels, etc.

PaO₂/FiO₂

3. It should be assessed under standardized conditions (e.g., measured at predefined FiO₂ and PEEP levels)

4. Categorization may include the threshold of 150 mmHg (< 150, ≥ 150)

Measures of severity

Two measures of “true” severity of ARDS:

5. Lung injury per se: “Severe” ARDS should not be based only on PaO₂/FiO₂

6. Severity of patient illness, including comorbidities and frailty

Enrichment strategies

7. Prediction or prognostic enrichment strategies for inclusion of patients into therapeutic clinical trials. The use of artificial intelligence techniques may help

Pulmonary circulation

8. More precise information about the anatomic/physiologic state of the pulmonary vascular circulation

Stratification, classification, or sub-phenotyping

9. An updated definition requires a new categorization or classification of severity based on gas-exchange, lung imaging, VD/VT, biomarker levels, use of non-invasive mechanical ventilation, degree of vascular permeability

Broadening definition

10. Excessive broadening of criteria required to diagnose ARDS should be avoided

International professional societies

11. Recommendations for management and treatment in the new updated ARDS definition should be implemented by International Professional Societies

Implementation

12. Implementation of a “Surviving ARDS (including patients at risk for) Campaign” with frequent updates