A new definition for ARDS was proposed at the recent ESICM Annual Congress, in October of this year. It was arrived at by an expert consensus panel that consisted largely of European clinicians and researchers, with input from the American Thoracic Society. They have attempted to evolve the original American-European definition that is the most widely used of current definitions, by considering not only the P/F ratio, CXR infiltrates and differentiation between cardiogenic and non-cardiogenic oedema, but also the timing and potential precipitants. Additionally, they have startified ARDS into mild, moderate and severe, with resulting implications for therapeutic interventions and prognosis. They have tried to construct it so that it is useful to both clinical researchers and day-to-day clinicians. |
Here is a slide from Marco’s presentation that outlines the Berlin definition ARDS criteria:
Some weak points have already been highlighted, such as the subjectiveness of the “Respiratory failure not adequately explained by cardiac failure or volume overload” criterion and the requirement to have an identified ARDS precipitant in order to make the diagnosis. However, this new definition still needs complete evaluation and, overall, it is a worthy attempt to update an old definition that predates current ARDS strategies and create one that is clinically useful.
You can check out Dr. Marco Ranieri’s (one of the Berlin definition authors) ESICM Annual Congress presentation here: http://www.esicm.org/07-congresses/0A-annual-congress/webTv_ranieri.asp