Acute respiratory distress syndrome diagnostic criteria: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Acute respiratory distress syndrome}} | {{Acute respiratory distress syndrome}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{BShaller}} | ||
==Overview== | ==Overview== | ||
Established by the | Established by the the European Society of Intensive Care Medicine in 2012, the Berlin definition is the most current set of diagnostic criteria for ARDS. | ||
==Diagnostic criteria== | ==Diagnostic criteria== | ||
{| class="wikitable" | ===The Berlin Definition of Acute Respiratory Distress Syndrome=== | ||
The diagnosis of ARDS is made when the following criteria are met:<ref name="pmid22797452">{{cite journal| author=ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E et al.| title=Acute respiratory distress syndrome: the Berlin Definition. | journal=JAMA | year= 2012 | volume= 307 | issue= 23 | pages= 2526-33 | pmid=22797452 | doi=10.1001/jama.2012.5669 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22797452 }} </ref> | |||
{| class="wikitable" style = "width: 900px" | |||
|- | |- | ||
! colspan="2" style="text-align: center;" | '''Acute Respiratory Distress Syndrome | ! colspan="2" style="text-align: center;" | '''The Berlin Definition of Acute Respiratory Distress Syndrome''' | ||
|- | |- | ||
| '''Timing''' | | '''Timing''' | ||
| ❑ Within 1 week of a known clinical insult or new or worsening respiratory symptoms | | ❑ Within 1 week of a known clinical insult or new or worsening respiratory symptoms | ||
|- | |- | ||
| '''Chest imaging''' <sup> | | '''Chest imaging''' <sup>a</sup> | ||
| ❑ [[Pulmonary consolidation|Bilateral opacities]] – not fully explained by [[Pulmonary Edema|effusions]], lobar/lung collapse, or [[Lung nodule| | | ❑ [[Pulmonary consolidation|Bilateral opacities]] – not fully explained by [[Pulmonary Edema|effusions]], lobar/lung collapse, or [[Lung nodule|nodules]] | ||
|- | |- | ||
| '''Origin of edema''' | | '''Origin of edema''' | ||
| ❑ [[Respiratory failure]] not fully explained by [[Heart failure|cardiac failure]] or [[Hypervolemia|fluid overload]] < | | ❑ [[Respiratory failure]] not fully explained by [[Heart failure|cardiac failure]] or [[Hypervolemia|fluid overload]] <br> ❑ Need objective assessment (e.g., [[Echocardiogram|echocardiography]]) to exclude [[Pulmonary Edema|hydrostatic edema]] if no risk factor present [[#risk_factor|(see below)]] | ||
|- | |- | ||
| colspan="2" style="text-align: left;" | ''' | | colspan="2" style="text-align: left;" | '''Oxygenation''' <sup>b</sup> | ||
|- | |- | ||
| | | | ||
: | :Mild | ||
| ❑ 200 mm Hg < [[PaO2|PaO<sub>2</sub>]]/[[FiO2| | | ❑ 200 mm Hg < [[PaO2|PaO<sub>2</sub>]]/[[FiO2|FiO<sub>2</sub>]] ≤ 300 mm Hg with [[PEEP]] or [[CPAP]] ≥ 5 cm H<sub>2</sub>O <sup>c</sup> | ||
|- | |- | ||
| | | | ||
: | :Moderate | ||
| ❑ 100 mm Hg < PaO<sub>2</sub>/ | | ❑ 100 mm Hg < [[PaO2|PaO<sub>2</sub>]]/[[FiO2|FiO<sub>2</sub>]] ≤ 200 mm Hg with [[PEEP]] ≥ 5 cm H<sub>2</sub>O | ||
|- | |- | ||
| | | | ||
: | :Severe | ||
| ❑ PaO<sub>2</sub>/FiO<sub>2</sub> ≤ 100 mm Hg with PEEP ≥ 5 cm H<sub>2</sub>O | | ❑ [[PaO2|PaO<sub>2</sub>]]/[[FiO2|FiO<sub>2</sub>]] ≤ 100 mm Hg with [[PEEP]] ≥ 5 cm H<sub>2</sub>O | ||
|- | |||
| colspan="2" | | |||
<span style="font-size: 85%;"><sup>a</sup> [[Chest radiograph]] or [[computed tomography]] scan.</span><br> | |||
<span style="font-size: 85%;"><sup>b</sup> If [[altitude]] is higher than 1000 m, the correction factor should be calculated as follows: <nowiki>[</nowiki>PaO<sub>2</sub>/FIO<sub>2</sub> × ([[barometric pressure]]/760)<nowiki>]</nowiki>.</span><br> | |||
<span style="font-size: 85%;"><sup>c</sup> This may be delivered [[Positive airway pressure|noninvasively]] in the mild ARDS group.</span> | |||
|- | |||
|} | |||
{| class="wikitable" style = "width: 900px;" | |||
|- | |||
! colspan="2" style="text-align: center;" | <span id="risk_factor">'''Risk Factors for Acute Respiratory Distress Syndrome'''</span> | |||
|- | |||
| style = "width: 50%;" | '''Direct''' | |||
| style = "width: 50%;" | '''Indirect''' | |||
|- | |||
| valign = top | | |||
* [[Pneumonia]] | |||
* [[Aspiration]] of gastric contents | |||
* [[Acute inhalation injury|Inhalational injury]] | |||
* [[Pulmonary contusion]] | |||
* Pulmonary [[vasculitis]] | |||
* [[Drowning]] | |||
| valign = top | | |||
* Non-pulmonary [[sepsis]] | |||
* Major [[trauma]] | |||
* [[Pancreatitis]] | |||
* Severe [[burns]] | |||
* Non-[[cardiogenic shock]] | |||
* [[Drug overdose]] | |||
* Multiple [[transfusion]]s or [[TRALI|transfusion-associated acute lung injury (TRALI)]] | |||
|- | |- | ||
|} | |} | ||
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[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
Latest revision as of 15:21, 13 July 2016
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Acute respiratory distress syndrome Microchapters |
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Differentiating Acute respiratory distress syndrome from other Diseases |
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Directions to Hospitals Treating Acute respiratory distress syndrome |
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Risk calculators and risk factors for Acute respiratory distress syndrome diagnostic criteria |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Brian Shaller, M.D. [2]
Overview
Established by the the European Society of Intensive Care Medicine in 2012, the Berlin definition is the most current set of diagnostic criteria for ARDS.
Diagnostic criteria
The Berlin Definition of Acute Respiratory Distress Syndrome
The diagnosis of ARDS is made when the following criteria are met:[1]
| The Berlin Definition of Acute Respiratory Distress Syndrome | |
|---|---|
| Timing | ❑ Within 1 week of a known clinical insult or new or worsening respiratory symptoms |
| Chest imaging a | ❑ Bilateral opacities – not fully explained by effusions, lobar/lung collapse, or nodules |
| Origin of edema | ❑ Respiratory failure not fully explained by cardiac failure or fluid overload ❑ Need objective assessment (e.g., echocardiography) to exclude hydrostatic edema if no risk factor present (see below) |
| Oxygenation b | |
|
❑ 200 mm Hg < PaO2/FiO2 ≤ 300 mm Hg with PEEP or CPAP ≥ 5 cm H2O c |
|
❑ 100 mm Hg < PaO2/FiO2 ≤ 200 mm Hg with PEEP ≥ 5 cm H2O |
|
❑ PaO2/FiO2 ≤ 100 mm Hg with PEEP ≥ 5 cm H2O |
|
a Chest radiograph or computed tomography scan. | |
| Risk Factors for Acute Respiratory Distress Syndrome | |
|---|---|
| Direct | Indirect |
|
|
References
- ↑ ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E; et al. (2012). "Acute respiratory distress syndrome: the Berlin Definition". JAMA. 307 (23): 2526–33. doi:10.1001/jama.2012.5669. PMID 22797452.