Acute respiratory distress syndrome diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Brian Shaller, M.D. [2]Roukoz A. Karam, M.D.[3]

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 study of choice

Diagnostic criteria:

The Berlin Definition of Acute Respiratory Distress Syndrome

The diagnosis of ARDS is made when the following criteria are met:

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
Mild	❑ 200 mm Hg < PaO2/FiO2 ≤ 300 mm Hg with PEEP or CPAP ≥ 5 cm H2O c
Moderate	❑ 100 mm Hg < PaO2/FiO2 ≤ 200 mm Hg with PEEP ≥ 5 cm H2O
Severe	❑ PaO2/FiO2 ≤ 100 mm Hg with PEEP ≥ 5 cm H2O
a Chest radiograph or computed tomography scan. b If altitude is higher than 1000 m, the correction factor should be calculated as follows: [PaO2/FIO2 × (barometric pressure/760)]. c This may be delivered noninvasively in the mild ARDS group.

Risk Factors for Acute Respiratory Distress Syndrome
Direct	Indirect
Pneumonia Aspiration of gastric contents Inhalational injury Pulmonary contusion Pulmonary vasculitis Drowning	Non-pulmonary sepsis Major trauma Pancreatitis Severe burns Non-cardiogenic shock Drug overdose Multiple transfusions or transfusion-associated acute lung injury (TRALI)