急性呼吸窘迫综合征(ARDS)柏林标准

发病时间

1周以内起病、或新发、或恶化的呼吸症状

胸部影像学

双肺模糊影—不能完全由渗出、肺塌陷或结节来解释

肺水肿起因

不能完全由心力衰竭或容量过负荷解释的呼吸衰竭.

没有发现危险因素时可行超声心动图等检查排除血流源性肺水肿

氧合指数

轻度

200 mmHg <PaO2/FiO2≤300mmHg with PPEP≥5cmH2O

中度

100 mmHg <PaO2/FiO2≤200mmHg with PPEP≥5cmH2O

重度

PaO2/FiO2≤100mmHg with PPEP ≥ 5cmH2O

Table The Berlin Definition of Acute Respiratory Distress Syndrome

Acute Respirtory Distress Syndrome

Timing

Within 1 week of known clinical insult or new or worsening respiratory symptoms

Chest imaging

Bilateral opacities-not fully explained by effusion,lobar/lung collapse, or nodules

Origin of edema

Respiratory failure not fully explained by cardiac failure or fluid overload

Need objective assessment(eg,echocardiography)to exclude hydrostatic edema if no risk factor present

Oxygenation

Mild

200mmHg< PaO₂/FiO₂≤300mmHg with PEEP or CAPA≥5cmH₂O

Moderate

100mmHg< PaO₂/FiO₂≤200mmHg with PEEP≥5cmH₂O

Severe

PaO₂/FiO₂≤100mmHg with PEEP≥5cmH₂O

AECC标准

The Berlin Definition

急性起病

确定具体时间

ALI

PaO2/FiO2≤300mmHg

是否有更科学的分类

氧合指数

PaO2/FiO2≤200mmHg，未考虑PEEP水平

将机械通气状态考虑进来

胸片

双肺弥漫性浸润

是否有更加量化的指标

PAWP

PAWP≤18mmHg,无左心房高压

PAWP还用考虑吗？

危险因素

无

考虑进来

The AECC definition-limitatioins and methods to address these in the Berlin definition

AECC definition

AECC limitations

Addressed in Berlin defintion

timing

Acute onset

No definition of acute

ALI category

All patients with PaO_2/FiO₂<300mmHg

Misinterpreted as PaO₂/FiO₂=201-300,leading to confusing ALI/ARDS term

3 Mutually exclusive subgroups of ARDS by severity

ALI term removed

oxygenation

PaO_2/FiO₂<300mmHg(regardless of PEEP)

Inconsistency of PaO₂/FiO₂ ration due to the effect of PEEP and/or FiO₂

Minimal PEEP level added across subgroups

FIO2 effect less relevant in severe ARDS

Chest radiograph

Bilateral infiltrates observed on frontal chest radiograph

Poor interoberver reliability of chest radiogrph interpretation

Chest radiogrph criteria clarified

Example radiographs created

PAWP

PAWP≤18mmHg when measured or no clinical evidence of left arterial hypertension

High PAWP and ARDS may coexist

Poor interobserver reliability of PAWP and clinical assessments of left atrial hypertention

PAWP requirement removed

Hydrostatic edema not the primary cause of respiratory failure

Clinical vignettes created to help exclude hydrostatic edema

Risk factor

None

Not formally included in definition

Included when none identified, need to objectively rule out hydrostatic edema