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{{Acute respiratory distress syndrome}}
{{Acute respiratory distress syndrome}}
{{CMG}}, {{AE}} {{BShaller}}
{{CMG}}; {{AE}} {{BShaller}}


==Overview==
==Overview==
Per the 2012 [[Acute respiratory distress syndrome#Diagnostic criteria|Berlin Definition]], ARDS is classified according to severity as ''mild'', ''moderate'', or ''severe''. These levels of severity are based on the degree to which [[oxygenation]] relative to the amount of [[supplemental oxygen]] being delivered to the patient via [[positive pressure ventilation]].
According to the Berlin definition, ARDS may be classified by the severity of oxygenation deficit into three subtypes: mild, moderate, and severe.


==Classification==
==Classification==
The current ARDS diagnostic criteria (commonly referred to as the ''Berlin Criteria'' or ''Berlin Definition'') were established by the ARDS Definition Task Force in 2012. [[Acute respiratory distress syndrome#Diagnostic Criteria|The Berlin Definition]] classifies ARDS as ''mild'', ''moderate'', and ''severe'' based on the degree of oxygenation impairment relative to the [[fraction of inspired oxygen|concentration of inspired oxygen]] being delivered to the patient via [[positive pressure ventilation]]. These three levels of severity serve as a means of risk-stratifying patients, as each level is associated with a mortality risk based on pooled data from a large patient population with ARDS.<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>
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 ARDS diagnostic criteria and risk stratification are discussed in greater detail in the [[Acute respiratory distress syndrome diagnostic criteria|subchapter on the diagnostic criteria for ARDS]].
The Berlin definitions of mild, moderate, and severe ARDS are as follows:
 
{| 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==
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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
Mild
200 mm Hg < PaO2/FiO2 ≤ 300 mm Hg with PEEP or CPAP ≥ 5 cm H2O
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

If altitude is higher than 1000 m, the correction factor should be calculated as follows: [PaO2/FIO2 × (barometric pressure/760)].
This may be delivered noninvasively in the mild ARDS group.

References

  1. 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.