In Reply Dr Tagami and colleagues highlight the potential of EVLW and PVPI in the diagnosis of ARDS. Indeed, the ARDS Definition Task Force considered variables such as EVLW and PVPI for inclusion as diagnostic criteria. At the time, the panel thought that the technology to measure these variables was relatively costly, invasive, and had methodological limitations.1 However, in patients without an ARDS risk factor, objective measurements such as EVLW or PVPI may help to rule out hydrostatic edema.2 The requirement for these criteria in the diagnosis of ARDS may further contribute to underrecognition in low- and middle-income countries where the technology may be less prevalent. Future consensus panels should consider the suitability of these variables for inclusion in a revised definition of ARDS.
Fan E, Brodie D, Slutsky AS. Diagnosis and Treatment in Acute Respiratory Distress Syndrome—Reply. JAMA. 2018;320(3):306. doi:10.1001/jama.2018.5932
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