Wednesday, October 15, 2014

“Berlin definition” of ARDS

“Berlin definition” of ARDS is a consensus panel's new definition and severity classification system for acute respiratory distress syndrome (ARDS). It aims to simplify the diagnosis and better prognosticate outcomes. It was published in JAMA, online May 21, 2012. It took into account cohort of 4,400 patients from past randomized trials.

Major departure from 1994 classification of ARDS was, there is no need to exclude heart failure in the new ARDS definition. Patients with high pulmonary capillary wedge pressures can still have ARDS. The new criterion is that respiratory failure simply be “not fully explained by cardiac failure or fluid overload,” in the physician’s best clinical judgment. An “objective assessment“– meaning an echocardiogram was highly recommended. The new Berlin definition for ARDS would also categorize ARDS as being mild, moderate, or severe:
  • Mild is P/F ratio of 200 – 300 with predicted mortality of 27%
  • Moderate is P/F ratio of100 – 200 with predicted mortality of 32%
  • Severe is P/F ratio less than 100 with predicted mortality of  45%
In 'Berlin definition', clinical variables that are widely believed to be important such as static compliance, radiographic severity and PEEP more than 10 — were not predictive of mortality or other clinical outcomes.

The panel’s findings, endorsed by the European Society of Intensive Care Medicine, the American Thoracic Society (ATS) and the Society of Critical Care Medicine (SCCM), emerged from meetings in Berlin to try to address the limitations of the earlier AECC definition.

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