Acute respiratory distress syndrome diagnostic criteria: Difference between revisions

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Latest revision as of 15:21, 13 July 2016

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
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)

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.

[pmid22797452-1] 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.

[1]

@@ Line 7: / Line 7: @@
 ==Diagnostic criteria==
-The diagnosis of ARDS is made when the following diagnostic 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"
+===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;" | '''The Berlin Definition of Acute Respiratory Distress Syndrome'''
@@ Line 16: / Line 19: @@
 | ❑ Within 1 week of a known clinical insult or new or worsening respiratory symptoms
 |-
-| '''Chest imaging''' <sup>'''a'''</sup>
+| '''Chest imaging''' <sup>a</sup>
 | ❑ [[Pulmonary consolidation|Bilateral opacities]] – not fully explained by [[Pulmonary Edema|effusions]], lobar/lung collapse, or [[Lung nodule|nodules]]
 |-
 | '''Origin of edema'''
-| ❑ [[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 [[Acute respiratory distress syndrome risk factors|risk factor]] present
+| ❑ [[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;" | '''[[Oxygenation]] <sup>b</sup>'''
+| colspan="2" style="text-align: left;" | '''Oxygenation''' <sup>b</sup>
 |-
 |
-:''Mild''<br>''(27% 90-day mortality rate)''
+:Mild
-| ❑ 200 mm Hg < [[PaO2|PaO<sub>2</sub>]]/[[FiO2|FIO<sub>2</sub>]] ≤ 300 mmHg with [[PEEP]] or [[CPAP]] > 5 cm H<sub>2</sub>O <sup>'''c'''</sup>
+| ❑ 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''<br>''(32% 90-day mortality rate)''
+:Moderate
-| ❑ 100 mm Hg < PaO<sub>2</sub>/FIO<sub>2</sub> ≤ 200 mm Hg with PEEP ≥ 5 cm H<sub>2</sub>O
+| ❑ 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''<br>''(45% 90-day mortality rate)''
+: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)]]
 |-
-! colspan="2" style="text-align: left;" |
-:<span style="font-size:85%; line-height: 0.0em;"><sup>'''a'''</sup> ''[[X-ray]] or [[CT scan]] of the chest''</span><br>
-:<span style="font-size:85%; line-height: 0.0em;"><sup>'''b'''</sup> ''If [[altitude]] is higher than 1000 m, the correction factor should be calculated as follows: PaO<sub>2</sub>/FIO<sub>2</sub> x ([[barometric pressure]]/760)''</span>
-:<span style="font-size:85%; line-height: 0.0em;"><sup>'''c'''</sup> ''[[Positive pressure ventilation|Positive pressure]] may be delivered [[Positive airway pressure|noninvasively]] in the mild ARDS group''</span><br>
 |}
@@ Line 46: / Line 74: @@
 [[Category:Pulmonology]]
-[[Category:FinalQCRequired]]
-{{WS}}
-{{WH}}