A New Global Definition of Acute Respiratory Distress Syndrome

Michael A. Matthay, Yaseen Arabi, Alejandro C. Arroliga, et al

Am J Respir Crit Care Med Published July 24, 2023

10.1164/rccm.202303-0558WS

Abstract

Background

Since the 2012 Berlin Definition of the Acute Respiratory Distress Syndrome (ARDS), several developments have supported the need for an expansion of the definition, including the use of high flow nasal oxygen (HFNO), expanding use of pulse oximetry in place of arterial blood gases, use of ultrasound for chest imaging, and the need for applicability in resource-limited settings.

Methods

A Consensus Conference of 32 critical care ARDS experts was convened, had six virtual meetings (June 2021-March 2022), and subsequently obtained input from members of several critical care societies. The goal was to develop a definition that would: (1) identify patients with the currently accepted conceptual framework for ARDS; (2) facilitate rapid ARDS diagnosis for clinical care and research; (3) be applicable in resource-limited settings; (4) be useful for testing specific therapies; and (5) be practical for communication to patients and caregivers.

Results

The committee made four main recommendations: (1) Include HFNO with a minimum flow rate of >= 30 liters/min; (2) Use arterial oxygen tension (PaO2)/FiO2 <= 300 mmHg or SpO2/FiO2 < 315 (if SpO2 <= 97%) to identify hypoxemia; (3) Retain bilateral opacities for imaging criteria but add ultrasound as an imaging modality, especially in resource-limited areas; and (4) In resource-limited settings, do not require PEEP, oxygen flow rate, or specific respiratory support devices.