The Berlin definition met our needs: no

Villar, Jesús; Pérez‐Méndez, Lina; Kacmarek, Robert M.

doi:10.1007/s00134-016-4242-6

Cited by 26 publications

(23 citation statements)

References 18 publications

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“…7 However, the Berlin definition of ARDS did not elaborate on several important mechanical ventilation settings and only indicated that the PEEP had to be $ 5 cm H 2 O for all 3 severity categories of ARDS. 7 Villar et al 8 stated that the stratification of severity of ARDS subjects as proposed by the Berlin criteria is useless for assessing severity of lung injury and could be harmful for enrolling subjects into clinical trials. Furthermore, Villar et al 9,10 reported in 2 separate studies that the same subjects in a certain ARDS severity category can be reclassified to another ARDS severity category by adequate consideration of the mechanical ventilation settings.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Oxygenation Factor and the Oxygenation Ratio in Subjects With ARDS

et al. 2020

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BACKGROUND: The oxygenation ratio (ie, P aO 2 /F IO 2) remains the most commonly used index for assessing oxygenation and disease severity in patients with acute ARDS. However, the oxygenation ratio does not account for mechanical ventilation settings. We hypothesized that the oxygenation factor (ie, oxygenation ratio/mean airway pressure) is superior to the oxygenation ratio in reflecting oxygenation in patients with ARDS and results in a different classification of ARDS severity. METHODS: In 150 subjects with ARDS (50 severe, 50 moderate, and 50 mild), arterial blood gas, mean airway pressure, static lung compliance, driving pressure, and mechanical power were obtained. The oxygenation ratio and the oxygenation factor were then calculated. Receiver operating characteristic curves were constructed for oxygenation ratio and oxygenation factor at lung compliance > 40 mL/cm H 2 O, driving pressure < 15 cm H 2 O, and mechanical power < 17 J/min, thresholds that are known to predict survival in patients with ARDS. Subjects were reclassified for ARDS severity on the basis of the oxygenation factor and compared to classification on the basis of the oxygenation ratio. RESULTS: Areas under the receiver operating characteristic curves for the oxygenation factor were significantly higher than for the oxygenation ratio. Reclassification of ARDS severity using the oxygenation factor did not affect subjects classified as having severe ARDS per the oxygenation ratio. However, 52% of subjects with moderate ARDS per the oxygenation ratio criteria were reclassified as either severe (25 subjects) or mild ARDS (1 subject) on the basis of oxygenation factor criteria. Also, 54% of subjects with mild ARDS per the oxygenation ratio criteria were reclassified as severe (4 subjects), moderate (21 subjects), or non-ARDS (2 subjects) on the basis of oxygenation factor criteria. CONCLUSIONS: The oxygenation factor was a superior ARDS oxygenation index compared to the oxygenation ratio and should be considered as a substitute criteria for classification of the severity of ARDS. (ClinicalTrials.gov registration NCT03946189.

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Section: Introductionmentioning

confidence: 99%

Comparison of the Oxygenation Factor and the Oxygenation Ratio in Subjects With ARDS

et al. 2020

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“…First, the current clinical tools cannot identify the pathological change of ARDS; second, the lack of a specific biomarker might influence diagnostic specificity; and third, the stratification of ARDS patients as proposed by the Berlin criteria is less useful for assessing the severity of lung injury and depends on the patient's therapeutic response. [ 9 ] More than 60.0% of patients with severe ARDS according to the Berlin criteria were reclassified as moderate, mild, or non-ARDS after 24 h of usual care, and hospital mortality changed significantly. [ 10 ] Finally, although the Berlin definition has higher predictive validity for mortality than the AECC definition, the specificity of the Berlin definition for ARDS was relatively poor when using diffuse alveolar damage as the reference standard, and the predictive validity of the Lung Injury Score for mortality was similar to the Berlin definition stages of severity with an area under the curve of 0.58 compared to 0.60.…”

Section: T He B Erlin D mentioning

confidence: 99%

Acute Respiratory Distress Syndrome

Pan

Liu

Xie

et al. 2018

Chinese Medical Journal

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Objective:Acute respiratory distress syndrome (ARDS) is a devastating clinical syndrome whose diagnosis and therapy are still in question. The aim of this review was to discuss the current challenge for the diagnosis and treatment of ARDS.Data Sources:Data sources were the published articles in English through December 2017 in PubMed using the following key words: “acute respiratory distress syndrome,” “definition”, “diagnosis,” “therapy,” “lung protective strategy,” “right ventricular dysfunction,” and “molecular mechanism.”Study Selection:The selection of studies focused on both preclinical studies and clinical studies of therapy of ARDS.Results:The incidence of ARDS is still high, and ARDS causes high intensive care units admissions and high mortality. The Berlin Definition proposed in 2012 is still controversial owing to lack of sensitivity and specificity. ARDS is still under recognition and it is associated with high mortality. Lung protective strategies with low tidal volume (VT) and lung recruitment should consider the physiology of ARDS because ARDS presents lung inhomogeneity; the same low VT might increase local stress and strain in some patients with low compliance, and lung recruitment could injure lungs in ARDS patients with low recruitability and hemodynamic instability. Acute cor pulmonale is common in severe ARDS. ARDS itself and some treatments could worsen acute cor pulmonale. Molecular understanding of the pathogenic contributors to ARDS has improved, but the molecular-associated treatments are still under development.Conclusions:ARDS is a devastating clinical syndrome whose incidence and mortality has remained high over the past 50 years. Its definition and treatments are still confronted with challenges, and early recognition and intervention are crucial for improving the outcomes of ARDS. More clinical studies are needed to improve early diagnosis and appropriate therapy.

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“…Trotz dieser unbestrittenen Fortschritte bleibt es schwierig, ein Syndrom, das sich auf dem Boden unterschiedlicher Grunderkrankungen mit unterschiedlicher Dynamik entwickeln kann, eigenständig zu definieren [6]. Messtechnische Probleme, die sich auf die Diagnosestellung auswirken, sind unter "Info -Einfluss der Beatmung" dargestellt.…”

Section: Problematik Der Definitionunclassified

ARDS – Ein Update – Teil 1: Epidemiologie, Pathophysiologie und Diagnostik

Dembinski¹,

Mielck²

2018

Anästhesiol Intensivmed Notfallmed Schmerzther

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The Acute Respiratory Distress Syndrome (ARDS) is defined by hypoxemic respiratory failure caused by inflammatory response within the lung usually requiring invasive mechanical ventilation. Despite more than 50 years of research numerous issues regarding epidemiology, pathophysiology and diagnosis remain unclear until today: Due to rather unspecific clinical diagnostic criteria incidence of ARDS varies considerably in clinical trials with a range from 4 to 79 cases per 100 000 persons per year. Consequently, mortality is also highly variable from about 40 to 60% in severe ARDS. Pathophysiology is mainly characterized by granulocyte infiltration of the lung thereby inducing interstitial and intra-alveolar lung edema with surfactant depletion and atelectasis formation. However, it is unknown whether pulmonary and extrapulmonary causes and risk factors for ARDS are accompanied by different pathophysiologic processes due to primary endothelial and epithelial injury. Thus, possible benefits of corresponding biomarker panels for the differentiation of endothelial and epithelial lung injury are also speculative until today. Therefore, ARDS diagnosis is still based on clinical findings and radiological imaging.

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The Berlin definition met our needs: no

Cited by 26 publications

References 18 publications

Comparison of the Oxygenation Factor and the Oxygenation Ratio in Subjects With ARDS

Comparison of the Oxygenation Factor and the Oxygenation Ratio in Subjects With ARDS

Acute Respiratory Distress Syndrome

ARDS – Ein Update – Teil 1: Epidemiologie, Pathophysiologie und Diagnostik

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