This means that some of the patients enrolled in this analysis did not completely fulfill Oligomycin A buy the Berlin definition.Pulmonary inflammation, that is, pneumonia, may affect the results obtained using the thermodilution technique. Inflamed cells and purulent matter, including microabscesses, might increase lung weight despite increased levels of EVLW. Further evaluation may be required to assess patients with ARDS secondary to direct injury caused by pneumonia.An EVLWi of ��10 mL/kg was used for defining pulmonary edema in this study, as reported previously. Although no definitive quantitative criteria for pulmonary edema were established, this value was selected on the basis of the value found in our recent human autopsy study and those used for defining pulmonary edema in previously reported studies.

Lowering the EVLWi value for pulmonary edema could have led to the inclusion of patients with less severe pulmonary edema, which may have influenced the results.In this study, each patient was managed with a PiCCO system for transpulmonary thermodilution monitoring of his circulatory/respiratory status. Therefore, patients with less severe ARDS may not have been selected for enrollment. Of 35 excluded patients, 14 were judged to have respiratory failure secondary to sepsis-induced increases in pulmonary vascular permeability but had to be excluded because they had previously presented EVLWi <10 mL/kg [21]. Nonetheless, there may exist a considerable number of patients meeting ARDS criteria with 'normal' EVLWi [38]. The inclusion and exclusion criteria used represent potential limitations of the study.

ConclusionsThe severity categories of ARDS laid out by the GSK-3 Berlin definition may be associated with increased EVLW and pulmonary microvascular permeability in patients who fulfilled the Berlin definition of ARDS with EVLWi ��10 mL/kg, which is the hallmark of lung pathophysiology. Moreover, this staging has good predictive validity for mortality, the severity of physiological derangements, and organ failure. These relationships require confirmation through further clinical research and critical care practice.Key messages- The categories of acute respiratory distress syndrome laid out by the Berlin definition may be associated with increased extravascular lung water and pulmonary microvascular permeability, which is the hallmark of lung pathophysiology.- The categories of the Berlin definition of disease progression are also associated with the severity of physiological derangements and the incidence of organ failure.