Acute respiratory distress syndrome sub-phenotypes according to histological findings

Abstract

The objective is to demonstrate that among patients with the clinical diagnosis of ARDS, the presence of diffuse alveolar damage (DAD) at histological examination, as compared to its absence, defines a clinical sub-phenotype. We studied patients that died in our ICU from 2000 to 2012 with the diagnosis of ARDS according to the Berlin definition and had autopsy. We excluded patients dying [14 days after the diagnosis of ARDS. The diagnosis of DAD required the presence of hyaline membranes plus at least one of the following: intra-alveolar edema, alveolar type I cell necrosis, alveolar type II cell proliferation, interstitial proliferation of fibroblasts or organizing interstitial fibrosis.