Acute respiratory distress syndrome diagnostic criteria

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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

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

Acute Respiratory Distress Syndrome – The Berlin Definition (2012)
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 nodule
Origin of edema	❑ Respiratory failure not fully explained by cardiac failure or fluid overload b
Oxygenation c
Mild (27% 90-day mortality rate)	❑ 200 mm Hg < PaO2/FIO2 ≤ 300 mmHg with PEEP or CPAP > 5 cm H2O d
Moderate (32% 90-day mortality rate)	❑ 100 mm Hg < PaO2/FIO2 ≤ 200 mm Hg with PEEP ≥ 5 cm H2O
Severe (45% 90-day mortality rate)	❑ PaO2/FiO2 ≤ 100 mm Hg with PEEP ≥ 5 cm H2O
a X-ray or CT scan of the chest b Need objective assessment (e.g., echocardiography) to exclude hydrostatic edema if no risk factor present c If altitude is higher than 1000 m, the correction factor should be calculated as follows: PaO2/FIO2 x (barometric pressure/760) d Positive pressure may be delivered noninvasively in the mild ARDS group