Global definition of ARDS
Pulmonology
Also known as: Berlin definition of ARDS · Globale ARDS-Definition · Berlin-Definition des ARDS · Küresel ARDS tanımı · Berlin ARDS tanımı · Global definition of acute respiratory distress syndrome (ARDS) 2023, with the Berlin definition 2012
What it is for
The 2023 global definition of acute respiratory distress syndrome (ARDS) keeps the Berlin framework and adds non-intubated patients on high-flow nasal oxygen, pulse oximetry (SpO2/FiO2) in place of blood gases, lung ultrasound, and a version for resource-limited settings. PaO2/FiO2: arterial oxygen partial pressure (mmHg) divided by the inspired oxygen fraction.
Classification
| Category | Description |
|---|---|
| Risk factor and origin | an acute predisposing risk factor (for example pneumonia, non-pulmonary infection, trauma, transfusion, aspiration or shock); the oedema is not primarily cardiogenic or due to fluid overload, and the hypoxaemia is not mainly due to atelectasis. |
| Timing | acute onset or worsening of hypoxaemic respiratory failure within 1 week of the risk factor or of new or worsening respiratory symptoms. |
| Imaging | bilateral opacities on chest radiograph or computed tomography, or bilateral B-lines and/or consolidations on lung ultrasound (trained operator), not fully explained by effusions, atelectasis or nodules/masses. |
| Non-intubated ARDS | PaO2/FiO2 ≤300 mmHg or SpO2/FiO2 ≤315 (with SpO2 ≤97%) on high-flow nasal oxygen ≥30 L/min or on non-invasive ventilation/continuous positive airway pressure (CPAP) with an end-expiratory pressure ≥5 cmH2O. |
| Intubated ARDS (PEEP ≥5 cmH2O) | mild: PaO2/FiO2 >200 to ≤300 or SpO2/FiO2 >235 to ≤315; moderate: PaO2/FiO2 >100 to ≤200 or SpO2/FiO2 >148 to ≤235; severe: PaO2/FiO2 ≤100 or SpO2/FiO2 ≤148 (SpO2/FiO2 only with SpO2 ≤97%). PEEP: positive end-expiratory pressure. |
| Resource-limited settings | SpO2/FiO2 ≤315 (SpO2 ≤97%) without a required PEEP, oxygen flow or support device (formalises the Kigali modification). |
| Berlin definition 2012 (previous) | onset within 1 week, bilateral opacities, not fully explained by cardiac failure or fluid overload; needed invasive or non-invasive ventilation with PEEP or CPAP ≥5 cmH2O; mild PaO2/FiO2 >200 to ≤300, moderate >100 to ≤200, severe ≤100 mmHg. Patients on high-flow nasal oxygen alone did not qualify. |
Source
A New Global Definition of Acute Respiratory Distress Syndrome
Am J Respir Crit Care Med 2024;209:37-47 (Matthay MA et al.)
DOI: 10.1164/rccm.202303-0558WS
PMID: 37487152
- Edition
- Global definition of ARDS (consensus 2023, published 2024); extends the Berlin definition (2012)
- Checked on
Summary of the published classification in our own words. Not a substitute for the original publication.
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