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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1573-1582
Number of pages10
JournalIntensive Care Medicine
Volume38
Issue number10
DOIs
StatePublished - Oct 2012

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Keywords

  • Adult
  • Artificial
  • Diagnosis
  • International cooperation
  • Prognosis
  • Respiration
  • Respiratory distress syndrome
  • Risk factors

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Ferguson, N. D., Fan, E., Camporota, L., Antonelli, M., Anzueto, A., Beale, R., Brochard, L., Brower, R., Esteban, A., Gattinoni, L., Rhodes, A., Slutsky, A. S., Vincent, J. L., Rubenfeld, G. D., Taylor Thompson, B., & Marco Ranieri, V. (2012). The Berlin definition of ARDS: An expanded rationale, justification, and supplementary material. Intensive Care Medicine, 38(10), 1573-1582. https://doi.org/10.1007/s00134-012-2682-1