Consensus conference definitions for sepsis, septic shock, acute lung injury, and acute respiratory distress syndrome: Time for a reevaluation

Definitions for sepsis, septic shock, acute lung injury (ALI), and acute re spiratory distress syndrome (ARDS) were developed by consensus conferences with the goal of achieving standardization of terminology and improved homo geneity of patient populations in clinical studies. Although such definitio ns have been useful in epidemiologic investigations, the criteria specified by the consensus conferences are broad and insufficiently specific to addr ess the problem of heterogeneous mechanisms leading to clinical syndromes, An important challenge is to progress from clinical syndromes, as presently defined, to more specific entities that are delineated by alterations in s pecific immunologic or biochemical pathways. Such mechanistic definitions w ill provide more homogeneous groups of patients who can be identified at ea rly stages of their clinical course. This approach encourages focused inves tigation of pathways leading to organ system dysfunction and death and, als o, provides an efficient framework for the development of new therapies use ful in critically ill patients.