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Intensive Care Medicine
Published in: Intensive Care Medicine 10/2012

01-10-2012 | Special Article

The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material

Authors: Niall D. Ferguson, Eddy Fan, Luigi Camporota, Massimo Antonelli, Antonio Anzueto, Richard Beale, Laurent Brochard, Roy Brower, Andrés Esteban, Luciano Gattinoni, Andrew Rhodes, Arthur S. Slutsky, Jean-Louis Vincent, Gordon D. Rubenfeld, B. Taylor Thompson, V. Marco Ranieri

Published in: Intensive Care Medicine | Issue 10/2012

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Abstract

Purpose

Our objective was to revise the definition of acute respiratory distress syndrome (ARDS) using a conceptual model incorporating reliability and validity, and a novel iterative approach with formal evaluation of the definition.

Methods

The European Society of Intensive Care Medicine identified three chairs with broad expertise in ARDS who selected the participants and created the agenda. After 2 days of consensus discussions a draft definition was developed, which then underwent empiric evaluation followed by consensus revision.

Results

The Berlin Definition of ARDS maintains a link to prior definitions with diagnostic criteria of timing, chest imaging, origin of edema, and hypoxemia. Patients may have ARDS if the onset is within 1 week of a known clinical insult or new/worsening respiratory symptoms. For the bilateral opacities on chest radiograph criterion, a reference set of chest radiographs has been developed to enhance inter-observer reliability. The pulmonary artery wedge pressure criterion for hydrostatic edema was removed, and illustrative vignettes were created to guide judgments about the primary cause of respiratory failure. If no risk factor for ARDS is apparent, however, objective evaluation (e.g., echocardiography) is required to help rule out hydrostatic edema. A minimum level of positive end-expiratory pressure and mutually exclusive PaO2/FiO2 thresholds were chosen for the different levels of ARDS severity (mild, moderate, severe) to better categorize patients with different outcomes and potential responses to therapy.

Conclusions

This panel addressed some of the limitations of the prior ARDS definition by incorporating current data, physiologic concepts, and clinical trials results to develop the Berlin definition, which should facilitate case recognition and better match treatment options to severity in both research trials and clinical practice.
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Metadata
Title
The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material
Authors
Niall D. Ferguson
Eddy Fan
Luigi Camporota
Massimo Antonelli
Antonio Anzueto
Richard Beale
Laurent Brochard
Roy Brower
Andrés Esteban
Luciano Gattinoni
Andrew Rhodes
Arthur S. Slutsky
Jean-Louis Vincent
Gordon D. Rubenfeld
B. Taylor Thompson
V. Marco Ranieri
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 10/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-012-2682-1

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