29. ARDS

Question 1

Diagnostic “ Berlin” criteria include:

Answer 1

1] acute onset, meaning onset over 1 week or less

2]bilateral opacities consistent with pulmonary edema must be present and may be detected on CT or chest radiograph

3] PF ratio <300mmHg (40kPa) with a minimum of 5 cmH20 PEEP (or CPAP)

4] “must not be fully explained by cardiac failure or fluid overload,”
in the physician’s best estimation using available information -
an “objective assessment” (e.g. echocardiogram) should be performed in most cases if there is no clear cause such as trauma or sepsis.

Question 2

ARDS can be further subivided according to severity as defined by PaO2/FiO2 ratios:

Answer 2

ARDS can be further subivided according to severity as defined by PaO2/FiO2 ratios:

Mild (200-300)
Moderate (100-200)
Severe (<100)

Question 3

ARDS net Criteria

Answer 3

The term acute lung injury is no longer in use.

The ARDSnet criteria recommend using tidal volumes of 6 ml/kg ideal body weight, keeping plateau pressures <30 cmH2O, using PEEP to optimise oxygenation and keeping the PaO2 above 8 kPa.