Acute respiratory distress syndrome classification: Difference between revisions
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{{Acute respiratory distress syndrome}} | {{Acute respiratory distress syndrome}} | ||
{{CMG}}; {{AE}} {{BShaller}} | |||
==Overview== | |||
According to the Berlin definition, ARDS may be classified by the severity of oxygenation deficit into three subtypes: mild, moderate, and severe. | |||
==Classification== | |||
ARDS may be classified according to the [[Acute respiratory distress syndrome diagnostic criteria|Berlin Definition]] into three mutually exclusive subtypes: mild, moderate, and severe. These levels of severity are based on the [[Fraction of inspired oxygen#PaO2/FiO2 ratio|PF ratio]], the degree of [[oxygenation]] relative to the fraction of [[oxygen]] participating in [[gas exchange]]. Data from the pooled cohorts demonstrated that mild, moderate, and severe ARDS were associated with increased 90-day [[mortality]] (27%, 32%, and 45%, respectively) and increased median duration of [[mechanical ventilation]] among survivors (5 days, 7 days, and 9 days, respectively).<ref name="pmid22797452">{{cite journal| author=ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E | display-authors=etal| 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=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22797452 }} </ref> | |||
{| | The Berlin definitions of mild, moderate, and severe ARDS are as follows: | ||
! '''Acute Respiratory Distress Syndrome''' | {| class="wikitable" | ||
|- | |||
! colspan="2" | '''The Berlin Definition of Acute Respiratory Distress Syndrome''' | |||
|- | |||
| colspan="2" | Oxygenation <sup>†</sup> | |||
|- | |||
| | |||
:Mild | |||
| 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>‡</sup> | |||
|- | |- | ||
| | | | ||
:Moderate | |||
| 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 | ||
| [[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>†</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>‡</sup> This may be delivered [[Positive airway pressure|noninvasively]] in the mild ARDS group.</span> | |||
|- | |- | ||
|} | |} | ||
==References== | ==References== | ||
{{reflist|2}} | |||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
Latest revision as of 18:33, 19 April 2020
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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]
Overview
According to the Berlin definition, ARDS may be classified by the severity of oxygenation deficit into three subtypes: mild, moderate, and severe.
Classification
ARDS may be classified according to the Berlin Definition into three mutually exclusive subtypes: mild, moderate, and severe. These levels of severity are based on the PF ratio, the degree of oxygenation relative to the fraction of oxygen participating in gas exchange. Data from the pooled cohorts demonstrated that mild, moderate, and severe ARDS were associated with increased 90-day mortality (27%, 32%, and 45%, respectively) and increased median duration of mechanical ventilation among survivors (5 days, 7 days, and 9 days, respectively).[1]
The Berlin definitions of mild, moderate, and severe ARDS are as follows:
| The Berlin Definition of Acute Respiratory Distress Syndrome | |
|---|---|
| Oxygenation † | |
|
200 mm Hg < PaO2/FiO2 ≤ 300 mm Hg with PEEP or CPAP ≥ 5 cm H2O ‡ |
|
100 mm Hg < PaO2/FiO2 ≤ 200 mm Hg with PEEP ≥ 5 cm H2O |
|
PaO2/FiO2 ≤ 100 mm Hg with PEEP ≥ 5 cm H2O |
|
† If altitude is higher than 1000 m, the correction factor should be calculated as follows: [PaO2/FIO2 × (barometric pressure/760)]. | |
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.