And So It Goes....

Septic related lung injury (ARDS), as presently defined, is a clinical description, not a disease - based on a blood gas and a chest x-ray in the absence of heart failure. 

The metrics are crude and highly confounded and do not distinguish specific disease. Just look at our largest post mortem analysis of so called ' ARDS' pts by Hemptinne et al, Chest and realize our present definition of ARDS included 13 different diseases at autopsy as diverse as diffuse alveolar damage to pulmonary infarct, to usual interstitial pneumonia, to hemorrhage. How then can we hope to advance disease specific care if we insist on using tired old insensitive metrics that do not distinguish disease?

But do we have disease specific therapies? 

Not really. If we had a therapy that worked at the cellular level to effectively decrease endothelial permeability it would become imperative to measure permeability or at least its surrogate - extra vascular lung water (EVLWi)  - but we don't. And so the arguing goes on. 

To significantly advance care we simply must design ways to identify pathophysiology at the cellular level and tailor therapies to these changes. But the horse here is the development of disease specific therapy - the cart, metrics that identify these specific diseases. And, for the most part, we have no horse. 

But in the meantime can we at least distinguish septic related permeability injury from early interstitial lung disease by measuring EVLW/PVPI? Or if convinced it's diffuse alveolar inflammatory damage - that our attempts at diuresis are working? Or using EVLWI to try to avoid drowning the lung in our 'resuscitative' efforts in the first place?

 

Apparently not as per Berlin  

 

And so it goes.....