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[Clinical practice in ARDS -the present and the future--].

ARDS is a syndrome characterized by nonhydrostatic pulmonary edema and hypoxemia due to overwhelming pulmonary inflammation arising secondarily from several pulmonary or non-pulmonary diseases. Since its introduction in 1967 by Ashbough, there had not been any gold standard concerning its definitive diagnosis over the next 25 years. In 1994, American-European Consensus Conference (AECC) published a definition that thereafter has been used for nearly 20 years. With this definition, a large number of randomized control trials were performed. Whereas, there are several criticisms against this definition. In 2011, European Society of Intensive Care Medicine convened a meeting with ARDS experts to make a new revised definition, now called Berlin definition. This definition is almost compatible with AECC criteria but more feasible and has more precise predictive validity and reliability. The Berlin definition should facilitate the recognition of ARDS and would offer more suitable treatment and enable clinical trials in accordance with disease severity.