Skip to main content
SpringerLink
Log in

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

  • Chapter
  • First Online:
Acute Respiratory Distress Syndrome

  • 1631 Accesses

Abstract

Acute 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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Matthay MA, McAuley DF, Ware LB. Clinical trials in acute respiratory distress syndrome: challenges and opportunities. Lancet Respir Med. 2017;5(6):524–34. https://doi.org/10.1016/S2213-2600(17)30188-1.

    Article  PubMed  Google Scholar 

  2. Bernard GR. Acute respiratory distress syndrome: a historical perspective. Am J Respir Crit Care Med. 2005;172(7):798–806. https://doi.org/10.1164/rccm.200504-663OE.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Li W, Pauluhn J. Phosgene-induced acute lung injury (ALI): differences from chlorine-induced ALI and attempts to translate toxicology to clinical medicine. Clin Transl Med. 2017;6(1):19. https://doi.org/10.1186/s40169-017-0149-2.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Fishman AP. Shock lung: a distinctive nonentity. Circulation. 1973;47(5):921–3. https://doi.org/10.1161/01.cir.47.5.921.

    Article  CAS  PubMed  Google Scholar 

  5. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2(7511):319–23.

    Article  CAS  PubMed  Google Scholar 

  6. Petty TL. In the cards was ARDS: how we discovered the acute respiratory distress syndrome. Am J Respir Crit Care Med. 2001;163(3 Pt 1):602–3.

    Article  CAS  PubMed  Google Scholar 

  7. Petty TL, Ashbaugh DG. The adult respiratory distress syndrome. Clinical features, factors influencing prognosis and principles of management. Chest. 1971;60(3):233–9.

    Article  CAS  PubMed  Google Scholar 

  8. Garber BG, Hebert PC, Yelle JD, Hodder RV, McGowan J. Adult respiratory distress syndrome: a systemic overview of incidence and risk factors. Crit Care Med. 1996;24(4):687–95.

    Article  CAS  PubMed  Google Scholar 

  9. Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988;138(3):720–3.

    Article  CAS  PubMed  Google Scholar 

  10. Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, et al. Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med. 1998;158(4):1076–81.

    Article  CAS  PubMed  Google Scholar 

  11. Kangelaris KN, Calfee CS, May AK, Zhuo H, Matthay MA, Ware LB. Is there still a role for the lung injury score in the era of the Berlin definition ARDS? Ann Intensive Care. 2014;4(1):4. https://doi.org/10.1186/2110-5820-4-4.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European consensus conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818–24.

    Article  CAS  PubMed  Google Scholar 

  13. Ketcham SW, Sedhai YR, Miller HC, Bolig TC, Ludwig A, Co I, et al. Causes and characteristics of death in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: a retrospective cohort study. Crit Care. 2020;24(1):391. https://doi.org/10.1186/s13054-020-03108-w.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ware LB, Matthay MA. Medical progress: the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1334–49.

    Article  CAS  PubMed  Google Scholar 

  15. De Hemptinne Q, Remmelink M, Brimioulle S, Salmon I, Vincent JL. ARDS: a clinicopathological confrontation. Chest. 2009;135(4):944–9.

    Article  PubMed  Google Scholar 

  16. Villar J, Kacmarek RM. The American-European consensus conference definition of the acute respiratory distress syndrome is dead, long live positive end-expiratory pressure! Med Intensiva. 2012;36(8):571–5. https://doi.org/10.1016/j.medine.2012.10.011.

    Article  CAS  PubMed  Google Scholar 

  17. Rubenfeld GD, Caldwell E, Granton J, Hudson LD, Matthay MA. Interobserver variability in applying a radiographic definition for ARDS. Chest. 1999;116(5):1347–53.

    Article  CAS  PubMed  Google Scholar 

  18. Meade MO, Cook RJ, Guyatt GH, Groll R, Kachura JR, Bedard M, et al. Interobserver variation in interpreting chest radiographs for the diagnosis of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2000;161(1):85–90.

    Article  CAS  PubMed  Google Scholar 

  19. Connors AF Jr, Speroff T, Dawson NV, Thomas C, Harrell FE Jr, Wagner D, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT investigators. JAMA. 1996;276(11):889–97.

    Article  PubMed  Google Scholar 

  20. Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354(21):2213–24.

    Article  PubMed  Google Scholar 

  21. Ferguson ND, Davis AM, Slutsky AS, Stewart TE. Development of a clinical definition for acute respiratory distress syndrome using the Delphi technique. J Crit Care. 2005;20(2):147–54. https://doi.org/10.1016/j.jcrc.2005.03.001.

    Article  PubMed  Google Scholar 

  22. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637. https://doi.org/10.1097/CCM.0b013e31827e83af.

    Article  PubMed  Google Scholar 

  23. Ferguson ND, Frutos-Vivar F, Esteban A, Fernandez-Segoviano P, Aramburu JA, Najera L, et al. Acute respiratory distress syndrome: underrecognition by clinicians and diagnostic accuracy of three clinical definitions. Crit Care Med. 2005;33(10):2228–34.

    Article  PubMed  Google Scholar 

  24. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526–33. https://doi.org/10.1001/jama.2012.5669.

    Article  CAS  PubMed  Google Scholar 

  25. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, et al. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353(16):1685–93.

    Article  CAS  PubMed  Google Scholar 

  26. Bersten AD, Edibam C, Hunt T, Moran J. Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian states. Am J Respir Crit Care Med. 2002;165(4):443–8.

    Article  PubMed  Google Scholar 

  27. Needham DM, Dennison CR, Dowdy DW, Mendez-Tellez PA, Ciesla N, Desai SV, et al. Study protocol: the improving care of acute lung injury patients (ICAP) study. Crit Care. 2006;10(1):R9. https://doi.org/10.1186/cc3948.

    Article  PubMed  Google Scholar 

  28. Britos M, Smoot E, Liu KD, Thompson BT, Checkley W, Brower RG, et al. The value of positive end-expiratory pressure and Fio2 criteria in the definition of the acute respiratory distress syndrome. Crit Care Med. 2011;39(9):2025–30. https://doi.org/10.1097/CCM.0b013e31821cb774.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Bellani G, Guerra L, Musch G, Zanella A, Patroniti N, Mauri T, et al. Lung regional metabolic activity and gas volume changes induced by tidal ventilation in patients with acute lung injury. Am J Respir Crit Care Med. 2011;183(9):1193–9. https://doi.org/10.1164/rccm.201008-1318OC.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Terragni PP, Rosboch G, Tealdi A, Corno E, Menaldo E, Davini O, et al. Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2007;175(2):160–6.

    Article  CAS  PubMed  Google Scholar 

  31. Terragni PP, Del Sorbo L, Mascia L, Urbino R, Martin EL, Birocco A, et al. Tidal volume lower than 6 ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal. Anesthesiology. 2009;111(4):826–35.

    Article  PubMed  Google Scholar 

  32. Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38(10):1573–82. https://doi.org/10.1007/s00134-012-2682-1.

    Article  PubMed  Google Scholar 

  33. Del Sorbo L, Ranieri VM, Ferguson ND. The Berlin definition met our needs: yes. Intensive Care Med. 2016;42(5):643–7. https://doi.org/10.1007/s00134-016-4286-7.

    Article  PubMed  Google Scholar 

  34. Vincent JL. The Berlin definition met our needs: not sure. Intensive Care Med. 2016;42(5):651–2. https://doi.org/10.1007/s00134-016-4319-2.

    Article  PubMed  Google Scholar 

  35. Sjoding MW, Hofer TP, Co I, Courey A, Cooke CR, Iwashyna TJ. Interobserver reliability of the Berlin ARDS definition and strategies to improve the reliability of ARDS diagnosis. Chest. 2018;153(2):361–7. https://doi.org/10.1016/j.chest.2017.11.037.

    Article  PubMed  Google Scholar 

  36. Kao KC, Hu HC, Chang CH, Hung CY, Chiu LC, Li SH, et al. Diffuse alveolar damage associated mortality in selected acute respiratory distress syndrome patients with open lung biopsy. Crit Care. 2015;19(1):228. https://doi.org/10.1186/s13054-015-0949-y.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Thille AW, Esteban A, Fernandez-Segoviano P, Rodriguez JM, Aramburu JA, Penuelas O, et al. Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy. Am J Respir Crit Care Med. 2013;187(7):761–7. https://doi.org/10.1164/rccm.201211-1981OC.

    Article  PubMed  Google Scholar 

  38. Villar J, Perez-Mendez L, Blanco J, Anon JM, Blanch L, Belda J, et al. A universal definition of ARDS: the PaO2/FiO2 ratio under a standard ventilatory setting – a prospective, multicenter validation study. Intensive Care Med. 2013;39(4):583–92. https://doi.org/10.1007/s00134-012-2803-x.

    Article  CAS  PubMed  Google Scholar 

  39. Villar J, Blanco J, del Campo R, Andaluz-Ojeda D, Diaz-Dominguez FJ, Muriel A, et al. Assessment of PaO2/FiO2 for stratification of patients with moderate and severe acute respiratory distress syndrome. BMJ Open. 2015;5(3):e006812. https://doi.org/10.1136/bmjopen-2014-006812.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788–800. https://doi.org/10.1001/jama.2016.0291.

    Article  CAS  PubMed  Google Scholar 

  41. Villar J, Schultz MJ, Kacmarek RM. The LUNG SAFE: a biased presentation of the prevalence of ARDS! Crit Care. 2016;20(1):108. https://doi.org/10.1186/s13054-016-1273-x.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Caser EB, Zandonade E, Pereira E, Gama AM, Barbas CS. Impact of distinct definitions of acute lung injury on its incidence and outcomes in Brazilian ICUs: prospective evaluation of 7,133 patients*. Crit Care Med. 2014;42(3):574–82. https://doi.org/10.1097/01.ccm.0000435676.68435.56.

    Article  PubMed  Google Scholar 

  43. Pham T, Rubenfeld GD. Fifty years of research in ARDS. The epidemiology of acute respiratory distress syndrome. A 50th birthday review. Am J Respir Crit Care Med. 2017;195(7):860–70. https://doi.org/10.1164/rccm.201609-1773CP.

    Article  PubMed  Google Scholar 

  44. Wilson JG, Calfee CS. ARDS subphenotypes: understanding a heterogeneous syndrome. Crit Care. 2020;24(1):102. https://doi.org/10.1186/s13054-020-2778-x.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Metwaly S, Cote A, Donnelly SJ, Banoei MM, Mourad AI, Winston BW. Evolution of ARDS biomarkers: will metabolomics be the answer? Am J Physiol Lung Cell Mol Physiol. 2018;315(4):L526–34. https://doi.org/10.1152/ajplung.00074.2018.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Calfee CS, Delucchi KL, Sinha P, Matthay MA, Hackett J, Shankar-Hari M, et al. Acute respiratory distress syndrome subphenotypes and differential response to simvastatin: secondary analysis of a randomised controlled trial. Lancet Respir Med. 2018;6(9):691–8. https://doi.org/10.1016/S2213-2600(18)30177-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB. Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS. Chest. 2007;132(2):410–7. https://doi.org/10.1378/chest.07-0617.

    Article  PubMed  Google Scholar 

  48. Bass CM, Sajed DR, Adedipe AA, West TE. Pulmonary ultrasound and pulse oximetry versus chest radiography and arterial blood gas analysis for the diagnosis of acute respiratory distress syndrome: a pilot study. Crit Care. 2015;19:282. https://doi.org/10.1186/s13054-015-0995-5.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Riviello ED, Kiviri W, Twagirumugabe T, Mueller A, Banner-Goodspeed VM, Officer L, et al. Hospital incidence and outcomes of the acute respiratory distress syndrome using the Kigali modification of the Berlin definition. Am J Respir Crit Care Med. 2016;193(1):52–9. https://doi.org/10.1164/rccm.201503-0584OC.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Satoru Hashimoto

Authors
  1. Satoru Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Satoru Hashimoto .

Editor information

Editors and Affiliations

  1. Department of Respiratory Medicine, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan

    Sadatomo Tasaka

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hashimoto, S. (2022). Definition of ARDS: Does the Berlin Definition Fit the Clinical Entity and Predict the Outcome?. In: Tasaka, S. (eds) Acute Respiratory Distress Syndrome. Respiratory Disease Series: Diagnostic Tools and Disease Managements. Springer, Singapore. https://doi.org/10.1007/978-981-16-8371-8_1

Download citation

  • DOI: https://doi.org/10.1007/978-981-16-8371-8_1

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-16-8370-1

  • Online ISBN: 978-981-16-8371-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation