Anestéziológia a intenzívna medicína 2/2013

ARDS – new definition

The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC). After 20 years of research and clinical practice since then, issues regarding the reliability and validity of this definition have emerged. A panel of experts convened in 2011 and developed the Berlin Definition. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mmHg <PaO2/FIO2 ≤300 mmHg), moderate (100 mmHg <PaO2/FIO2 ≤200 mmHg), and severe (PaO2/FIO2 ≤100 mmHg) and excluded the term ALI. Four ancillary variables for severe ARDS were proposed: radiographic severity, respiratory system compliance (≤40 mL/cm H2O), positive endexpiratory pressure (≥10 cm H2O), and corrected expired volume per minute (≥10 L/min). The 4 variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Compared with the AECC definition, the final Berlin Definition had better predictive validity for mortality. This updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition.

Keywords: ARDS, Berlin definition, variables, validity.