Acute Respiratory Distress Syndrome in Veterinary Medicine-The ARDSVet Definitions.

Abstract

OBJECTIVE: To use a systematic, evidence-based consensus process to develop updated definitions for acute respiratory distress syndrome (ARDS) in veterinary medicine to facilitate its recognition and diagnosis. DESIGN: International consensus conference series involving 12 multidisciplinary international content experts from three countries, using consensus conference methodology and implementation science. A systematic review of the literature was carried out for ARDS and acute lung injury in veterinary medicine. Updated definitions of ARDS were generated based on synthesis of human and veterinary literature. Consensus on the definitions was achieved through Delphi-style surveys involving the above subject matter experts. Draft recommendations were made available through industry specialty listservs for feedback, which was incorporated in the final definitions. RESULTS: Updated definitions were developed for Veterinary Acute Respiratory Distress Syndrome (ARDSVet) in small animals (dogs and cats) and large animals (equids). For small animals, 690 publications were identified for dogs and 99 were identified for cats in the initial literature search. Seventeen cats and 103 dogs with ARDS were represented across these publications. For the initial literature search in large animals, there were 83 equid, five camelid, 158 pig, 714 sheep and goat, and 270 cattle publications identified. Additionally, 1084 publications were found across all large animals that addressed interstitial lung disease. Five adult equids and 136 foals with ARDS were represented across these publications. The updated ARDSVet definitions incorporate criteria for risk factors, origin and timing of pulmonary edema, and impaired oxygenation, with severity stratified by oxygenation and definitions for both intubated and nonintubated animals. CONCLUSIONS: The evidence review and consensus process resulted in updated definitions that can be used to improve the recognition of veterinary ARDS as well as facilitate and standardize future research, including the development of an ARDS registry and eventual treatment recommendations.