{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T13:45:53Z","timestamp":1787579153949,"version":"build-2736575974"},"reference-count":82,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T00:00:00Z","timestamp":1638921600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Acute respiratory distress syndrome (ARDS) is a life-threatening condition defined by the acute onset of severe hypoxemia with bilateral pulmonary infiltrates, in the absence of a predominant cardiac involvement. Whereas the current Berlin definition was proposed in 2012 and mainly focused on intubated patients under invasive mechanical ventilation, the recent COVID-19 pandemic has highlighted the need for a more comprehensive definition of ARDS including patients treated with noninvasive oxygenation strategies, especially high-flow nasal oxygen therapy, and fulfilling all other diagnostic criteria. Early identification of ARDS in patients breathing spontaneously may allow assessment of earlier initiation of pharmacological and non-pharmacological treatments. In the same way, accurate identification of the ARDS etiology is obviously of paramount importance for early initiation of adequate treatment. The precise underlying etiological diagnostic (bacterial, viral, fungal, immune, malignant, drug-induced, etc.) as well as the diagnostic approach have been understudied in the literature. To date, no clinical practice guidelines have recommended structured diagnostic work-up in ARDS patients. In addition to lung-protective ventilation with the aim of preventing worsening lung injury, specific treatment of the underlying cause has a central role to improve outcomes. In this review, we discuss early identification of ARDS in non-intubated patients breathing spontaneously and propose a structured diagnosis work-up.<\/jats:p>","DOI":"10.3390\/diagnostics11122307","type":"journal-article","created":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T21:52:32Z","timestamp":1639086752000},"page":"2307","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)"],"prefix":"10.3390","volume":"11","author":[{"given":"Fran\u00e7ois","family":"Arriv\u00e9","sequence":"first","affiliation":[{"name":"Centre Hospitalier Universitaire de Poitiers, M\u00e9decine Intensive R\u00e9animation, 86021 Poitiers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00e9mi","family":"Coudroy","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Poitiers, M\u00e9decine Intensive R\u00e9animation, 86021 Poitiers, France"},{"name":"Centre d\u2019Investigation Clinique 1402 ALIVE, INSERM, Universit\u00e9 de Poitiers, 86000 Poitiers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7798-6715","authenticated-orcid":false,"given":"Arnaud W.","family":"Thille","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Poitiers, M\u00e9decine Intensive R\u00e9animation, 86021 Poitiers, France"},{"name":"Centre d\u2019Investigation Clinique 1402 ALIVE, INSERM, Universit\u00e9 de Poitiers, 86000 Poitiers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S0140-6736(67)90168-7","article-title":"Acute respiratory distress in the adult","volume":"290","author":"Ashbaugh","year":"1967","journal-title":"Lancet"},{"key":"ref_2","first-page":"209","article-title":"Diffuse alveolar damage-The role of oxygen, shock, and related factors. 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