• Chronic systemic disease involving any major organ system (e.g. irreversible chronic CNS disease, chronic lung disease with FEV1 <1l, FEV1/FVC <0.3 of predicted, chronic PaCO2 >6.0kPa, emphysema or previous admission for chronic respiratory insufficiency, incurable or rapidly fatal malignancy, chronic left heart failure, chronic renal failure, chronic liver failure, HIV related disease).

• Lung failure for >7 days (although treatment with extracorporeal respiratory support may persist for longer than 14 days).

• More than 3 organ failures in addition to lung failure.

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