The value of positive end-expiratory pressure and Fio2 criteria in the definition of the acute respiratory distress syndrome*

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Abstract
The criteria that define acute lung injury and the acute respiratory distress syndrome include PaO2/Fio2 but not positive end-expiratory pressure or Fio2. PaO2/Fio2 ratios of some patients increase substantially after mechanical ventilation with positive end-expiratory pressure of 5–10 cm H2O, and the mortality of these patients may be lower than those whose PaO2/Fio2ratios remain 2 Analysis of baseline physiologic data and outcomes of patients previously enrolled in clinical trials conducted by the National Institutes of Health Acute Respiratory Distress Syndrome Network. Intensive care units of 40 hospitals in North America. Two thousand three hundred and twelve patients with acute lung injury/acute respiratory distress syndrome. None. Only 1.3% of patients enrolled in Acute Respiratory Distress Syndrome Network trials had baseline positive end-expiratory pressure 2 At Acute Respiratory Distress Syndrome Network hospitals, the addition of baseline positive end-expiratory pressure would not have increased the value of PaO2/Fio2 for predicting mortality of acute lung injury/acute respiratory distress syndrome patients. In contrast, the addition of baseline Fio2 to PaO2/Fio2 could be used to identify subsets of patients with low or high mortality.