Acute Respiratory Distress Syndrome

Berlin definition (JAMA 2012;307:2526)

  • Acute onset within 1 week of clinical insult or worsening respiratory status
  • Bilateral infiltrates without alternative explanation (eg, effusion, atelectasis, nodules)
  • Edema not fully explained by fluid overload or congestive heart failure
  • Hypoxemia: PaO2/FiO2 determined with 5 cm H2O of PEEP
    • PaO2/FiO2 200–300 = mild ARDS (may be on NPPV), 100–200 = mod, <100 = severe

Pathophysiology (Lancet 2016;388:2416)

  • ↑ intrapulmonary shunt → hypoxemia (∴ Rx w/ PEEP to revent derecruitment)