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Semin Respir Crit Care Med 2022; 43(03): 379-389
DOI: 10.1055/s-0042-1744306
Review Article

Insights Regarding the Berlin Definition of ARDS from Prospective Observational Studies

Ciara Hanley
1   Department of Anaesthesia and Intensive Care medicine, Galway University Hospitals, Saolta University Hospital Group, Galway, Ireland
,
Camilla Giacomini
1   Department of Anaesthesia and Intensive Care medicine, Galway University Hospitals, Saolta University Hospital Group, Galway, Ireland
,
Aoife Brennan
1   Department of Anaesthesia and Intensive Care medicine, Galway University Hospitals, Saolta University Hospital Group, Galway, Ireland
2   School of Medicine, National University of Ireland, Galway, Ireland
,
Bairbre McNicholas
1   Department of Anaesthesia and Intensive Care medicine, Galway University Hospitals, Saolta University Hospital Group, Galway, Ireland
2   School of Medicine, National University of Ireland, Galway, Ireland
,
John G. Laffey
1   Department of Anaesthesia and Intensive Care medicine, Galway University Hospitals, Saolta University Hospital Group, Galway, Ireland
2   School of Medicine, National University of Ireland, Galway, Ireland
3   Regenerative Medicine Institute, National University of Ireland, Galway, Ireland
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Abstract

The definition of acute respiratory distress syndrome (ARDS), has evolved since it was first described in 1967 by Ashbaugh and Petty to the current “Berlin” definition of ARDS developed in 2012 by an expert panel, that provided clarification on the definition of “acute,” and on the cardiac failure criteria. It expanded the definition to include patients receiving non-invasive ventilation, and removed the term “acute lung injury” and added a requirement of patients to be receiving a minimum 5 cmH2O expiratory pressure.

Since 2012, a series of observational cohort studies have generated insights into the utility and robustness of this definition. This review will examine novel insights into the epidemiology of ARDS, failures in ARDS diagnosis, the role of lung imaging in ARDS, the novel ARDS cohort that is not invasively ventilated, lung compliance profiles in patients with ARDS, sex differences that exist in ARDS management and outcomes, the progression of ARDS following initial diagnosis, and the clinical profile and outcomes of confirmed versus resolved ARDS. Furthermore, we will discuss studies that challenge the utility of distinguishing ARDS from other causes of acute hypoxemic respiratory failure (AHRF) and identify issues that may need to be addressed in a revised definition.

Keywords

acute respiratory distress syndrome - epidemiology - diagnosis - acute hypoxemic respiratory failure - lung injury - mechanical ventilation - non-invasive ventilation - outcomes


Publication History

Article published online:
09 June 2022

© 2022. Thieme. All rights reserved.

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