Definition of ARDS: Does the Berlin Definition Fit the Clinical Entity and Predict the Outcome?

Abstract

AbstractAcute respiratory distress syndrome (ARDS) is a collective term for the pathological conditions that develop acutely, following preexisting underlying diseases or injuries, resulting in extremely severe hypoxemia caused by non-hydrostatic pulmonary edema due to diffuse lung injury. Ever since its first description in 1967, the syndrome has been extensively investigated but continued as a contributor to the high mortality of patients in ICU settings. The American-European Consensus Conference (AECC) definition reported in 1994 was the first generally agreed-upon definition for ARDS. Although the AECC definition facilitated the many clinical trials, a number of limitations emerged. The Berlin definition established in 2012 was a revised version of the AECC definition maintaining a link to prior definition with refinement of diagnostic criteria of timing, chest imaging, origin of edema, and hypoxemia. The Berlin definition showed qualitative improvements over the AECC definition in several aspects. Three mutually exclusive categories of mild, moderate, and severe ARDS were validated as they were associated with higher mortality rates from mild to severe form of ARDS. The Berlin definition has been widely accepted, but it still has several limitations that require further investigations to establish a better definition of ARDS.KeywordsBerlin definitionAECC definitionClinical criteria