{"id":2306,"date":"2017-10-06T12:38:34","date_gmt":"2017-10-06T12:38:34","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/pulards2\/"},"modified":"2026-03-02T20:01:33","modified_gmt":"2026-03-02T20:01:33","slug":"pulards2","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/pulards2\/","title":{"rendered":"Berlin Definition of the Acute Respiratory Distress Syndrome (ARDS)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>The Berlin definition, proposed\u00a0in 2012,\u00a0breaks with tradition by establishing three risk strata that are\u00a0based on the degree of hypoxemia as assessed at a minimum positive end-expiratory\u00a0pressure (PEEP).<br \/>\n<!--more--><\/p>\n<p><b>Berlin Definition of the Acute Respiratory Distress Syndrome (ARDS)<\/b><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\"><b>Criteria\u00a0<\/b><\/p>\n<\/td>\n<td style=\"border: solid windowtext 1.0pt; border-left: none; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\"><b>Rationale<\/b><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">Onset within 7 days after a known clinical insult or new or worsening respiratory symptoms<\/p>\n<\/td>\n<td style=\"border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">Observational data suggest that ARDS will develop within 72 hr in the majority of patients at risk for the syndrome and within 1 wk in nearly all patients at risk<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">Bilateral opacities that are \u201cconsistent with pulmonary edema\u201d on chest radiographs or chest CT<\/p>\n<\/td>\n<td style=\"border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">There is poor interobserver reliability in interpreting the chest radiograph for the presence of edema. To address this issue, the Berlin definition offers more explicit criteria (e.g., opacities should not be fully explained by effusions, lobar or lung atelectasis, or nodules or masses), with illustrative radiographs provided<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">Categorization of ARDS severity<\/p>\n<\/td>\n<td style=\"border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">A patient-level meta-analysis validated three thresholds for hypoxemia, all consisting of a Pao2:Fio2 ratio &lt;\/=300 mm Hg<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">\u00a0 \u00a0 Mild<\/p>\n<\/td>\n<td style=\"border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">Pao2:Fio2, 201 to 300 mm Hg; mortality, 27% (95% CI, 24\u201330)<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">\u00a0 \u00a0 Moderate<\/p>\n<\/td>\n<td style=\"border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">Pao2:Fio2, 101 to 200 mm Hg; mortality, 32% (95% CI, 29\u201334)<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">\u00a0 \u00a0 Severe<\/p>\n<\/td>\n<td style=\"border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">Pao2:Fio2, &lt;\/=100 mm Hg; mortality, 45% (95% CI, 42\u201348)<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">Minimum PEEP setting or CPAP, 5 cm of water; Pao2:Fio2 assessed on invasive mechanical ventilation (CPAP criterion used for the diagnosis of mild ARDS)<\/p>\n<\/td>\n<td style=\"border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt;\" valign=\"top\">\n<p class=\"MsoNormal\">Estimates of Fio2 are not accurate with oxygen-delivery systems other than invasive or noninvasive ventilation (with a tight-fitting mask), with the exception of nasal high-flow oxygen delivery systems (at flow rates &gt;\/=45 liters per minute); requiring higher PEEP settings does not increase predictive validity of the Berlin severity strata and adds complexity<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"MsoNormal\">CI denotes confidence interval, CPAP continuous positive airway\u00a0pressure, Pao2:Fio2 ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen, and PEEP positive end-expiratory pressure.<\/p>\n<p>&nbsp;<\/p>\n<p><b>References:<\/b><\/p>\n<ol>\n<li>Thompson BT, Chambers RC, Liu KD. Acute Respiratory Distress Syndrome.\u00a0N Engl J Med. 2017 Aug 10;377(6):562-572. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28792873\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>De Luis Cabez\u00f3n N, S\u00e1nchez Castro I, Bengoetxea Uriarte UX, Rodrigo Casanova MP, Garc\u00eda Pe\u00f1a JM, Aguilera Celorrio L. Acute respiratory distress syndrome: a review of the Berlin definition.\u00a0Rev Esp Anestesiol Reanim. 2014 Jun-Jul;61(6):319-27. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24780650\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, Brochard L, Brower R, Esteban A, Gattinoni L, Rhodes A, Slutsky AS, Vincent JL, Rubenfeld GD, Thompson BT, Ranieri VM.The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012 Oct;38(10):1573-82. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22926653\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Gonzalez-Pizarro P, Suarez-Sipmann F. Acute Respiratory Distress Syndrome Definitions in Adults and Children: A Comparative Narrative Review. J Clin Med. 2025 Oct 28;14(21):7644. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41227040\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Oct 06, 2017.<br \/>\nUp-date Mar 2, 2026.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[233],"tags":[231,230,593,592,591,314,313,590,589,588,587,586,585,584,5,4],"class_list":["post-2306","post","type-post","status-publish","format-standard","hentry","category-pulmonary","tag-acute","tag-aguda","tag-agudo","tag-ards","tag-berlin","tag-definicion","tag-definition","tag-distres","tag-distress","tag-lung","tag-pulmon","tag-respiratorio","tag-respiratory","tag-sdra","tag-sindrome","tag-syndrome"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2306","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2306"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2306\/revisions"}],"predecessor-version":[{"id":10688,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2306\/revisions\/10688"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2306"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2306"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2306"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}