Acute respiratory distress syndrome - Revision history

Danbot: Add MedicationDose entries (methylprednisolone, cisatracurium) with SMW annotations

2026-03-20T18:49:48Z

Add MedicationDose entries (methylprednisolone, cisatracurium) with SMW annotations

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 *[[ECMO]]
 *[[Oscillation ventilation]], [[High frequency oscillation ventilation]] ([[HFOV]])
 ==Disposition==

Zbuchwald: /* Evaluation */

2025-07-15T15:57:38Z

Evaluation

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	====Diagnostic Criteria<ref name="Matthay"> Matthay, M. et al. (2024). A New Global Definition of Acute Respiratory Distress Syndrome. American Journal of Respiratory and Critical Care Medicine, 30(1), 37-47. https://doi.org/10.1164/rccm.202303-0558WS </ref>====		====Diagnostic Criteria<ref name="Matthay"> Matthay, M. et al. (2024). A New Global Definition of Acute Respiratory Distress Syndrome. American Journal of Respiratory and Critical Care Medicine, 30(1), 37-47. https://doi.org/10.1164/rccm.202303-0558WS </ref>====
	*'''Nonintubated ARDS'''		*'''Nonintubated ARDS'''
	**PaO2:~~FiO2 ⩽ 300 mm Hg~~ or SpO2:~~FiO2 ⩽ 315~~ (if ~~SpO2 ⩽ 97~~%) on HFNO with flow of ~~⩾30 L~~/min or NIV/CPAP with at least 5 cm H2O end-expiratory pressure		**PaO2:FiO2 ≤ 300 mm Hg or SpO2:FiO2 ≤ 315 (if SpO2 ≤ 97%) on HFNO with flow of ≥ 30 L/min or NIV/CPAP with at least 5 cm H2O end-expiratory pressure
	*'''Intubated ARDS'''		*'''Intubated ARDS'''
	**Mild: 200 < PaO2:~~FiO2 ⩽ 300~~ mm Hg or 235 < SpO2:~~FiO2 ⩽ 315~~ (if ~~SpO2 ⩽ 97~~%)		**Mild: 200 < PaO2:FiO2 ≤ 300 mm Hg or 235 < SpO2:FiO2 ≤ 315 (if SpO2 ≤ 97%)
	**Moderate: 100 < PaO2:~~FiO2 ⩽ 200~~ mm Hg or 148 < SpO2:~~FiO2 ⩽ 235~~ (if ~~SpO2 ⩽ 97~~%)		**Moderate: 100 < PaO2:FiO2 ≤ 200 mm Hg or 148 < SpO2:FiO2 ≤ 235 (if SpO2 ≤ 97%)
	**Severe: PaO2:~~FiO2 ⩽ 100~~ mm Hg or SpO2:~~FiO2 ⩽ 148~~ (if ~~SpO2 ⩽ 97~~%)		**Severe: PaO2:FiO2 ≤ 100 mm Hg or SpO2:FiO2 ≤ 148 (if SpO2 ≤ 97%)
	*'''Modified Definition for Resource Limited Settings'''		*'''Modified Definition for Resource Limited Settings'''
	**SpO2:~~FiO2 ⩽ 315~~ (if ~~SpO2 ⩽ 97~~%). Neither positive end-expiratory pressure nor a minimum flow rate of oxygen is required for diagnosis in resource-limited settings.		**SpO2:FiO2 ≤ 315 (if SpO2 ≤ 97%). Neither positive end-expiratory pressure nor a minimum flow rate of oxygen is required for diagnosis in resource-limited settings.

	==Management==		==Management==

Zbuchwald: /* Evaluation */

2025-07-15T15:52:58Z

Evaluation

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	====Diagnostic Criteria<ref name="Matthay"> Matthay, M. et al. (2024). A New Global Definition of Acute Respiratory Distress Syndrome. American Journal of Respiratory and Critical Care Medicine, 30(1), 37-47. https://doi.org/10.1164/rccm.202303-0558WS </ref>====		====Diagnostic Criteria<ref name="Matthay"> Matthay, M. et al. (2024). A New Global Definition of Acute Respiratory Distress Syndrome. American Journal of Respiratory and Critical Care Medicine, 30(1), 37-47. https://doi.org/10.1164/rccm.202303-0558WS </ref>====
	~~#New onset [[SOB\|respiratory symptoms]]~~		*'''Nonintubated ARDS'''
	~~#Bilateral pulmonary opacities~~		**PaO2:FiO2 ⩽ 300 mm Hg or SpO2:FiO2 ⩽ 315 (if SpO2 ⩽ 97%) on HFNO with flow of ⩾30 L/min or NIV/CPAP with at least 5 cm H2O end-expiratory pressure
	~~#Symptoms not explained by cardiac etiology~~ or ~~volume overload~~		*'''Intubated ARDS'''
			**Mild: 200 < PaO2:FiO2 ⩽ 300 mm Hg or 235 < SpO2:FiO2 ⩽ 315 (if SpO2 ⩽ 97%)
			**Moderate: 100 < PaO2:FiO2 ⩽ 200 mm Hg or 148 < SpO2:FiO2 ⩽ 235 (if SpO2 ⩽ 97%)
			**Severe: PaO2:FiO2 ⩽ 100 mm Hg or SpO2:FiO2 ⩽ 148 (if SpO2 ⩽ 97%)
			*'''Modified Definition for Resource Limited Settings'''
			**SpO2:FiO2 ⩽ 315 (if SpO2 ⩽ 97%). Neither positive end-expiratory pressure nor a minimum flow rate of oxygen is required for diagnosis in resource-limited settings.

	==Management==		==Management==

Zbuchwald: /* Prognosis */

2025-07-15T15:26:00Z

Prognosis

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	==Prognosis==		==Prognosis==
	===Severity (Berlin Definition)<ref name="Ferguson" /> Ferguson ND et. al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012 Oct;38(10):1573-82.</ref>===		===Severity (Berlin Definition)<ref name="Ferguson"> Ferguson ND et. al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012 Oct;38(10):1573-82.</ref>===
	{\| class="wikitable"		{\| class="wikitable"
	\| align="center" style="background:#f0f0f0;"\|'''PaO2/FiO2'''		\| align="center" style="background:#f0f0f0;"\|'''PaO2/FiO2'''

Zbuchwald: /* Evaluation */

2025-07-15T15:24:54Z

Evaluation

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	===Diagnosis===		===Diagnosis===
	*~~[[CXR]] shows diffuse patchy~~ pulmonary ~~infiltrates~~		*'''Risk factors and origin of edema'''
			**Precipitated by an acute predisposing risk factor, such as pneumonia, nonpulmonary infection, trauma, transfusion, aspiration, or shock. Pulmonary edema is not exclusively or primarily attributable to cardiogenic pulmonary edema/fluid overload, and hypoxemia/gas exchange abnormalities are not primarily attributable to atelectasis.
			*'''Timing'''
			**Acute onset or worsening of hypoxemic respiratory failure within 1 week of the estimated onset of the predisposing risk factor or new or worsening respiratory symptoms.
			*'''Chest Imaging'''
			**Bilateral opacities on chest radiography and computed tomography or bilateral B lines and/or consolidations on ultrasound

	====Diagnostic Criteria<ref name="~~Ferguson~~">~~Ferguson ND~~ et. al. ~~The Berlin definition~~ of ~~ARDS: an expanded rationale~~, ~~justification~~, ~~and supplementary material~~. ~~Intensive Care Med~~. ~~2012 Oct;38(~~10~~):1573~~-~~82.~~</ref>====		====Diagnostic Criteria<ref name="Matthay"> Matthay, M. et al. (2024). A New Global Definition of Acute Respiratory Distress Syndrome. American Journal of Respiratory and Critical Care Medicine, 30(1), 37-47. https://doi.org/10.1164/rccm.202303-0558WS </ref>====
	#New onset [[SOB\|respiratory symptoms]]		#New onset [[SOB\|respiratory symptoms]]
	#Bilateral pulmonary opacities		#Bilateral pulmonary opacities

Zbuchwald: /* Severity (Berlin Definition) */

2025-07-15T15:24:46Z

Severity (Berlin Definition)

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	==Prognosis==		==Prognosis==
	===Severity (Berlin Definition)<ref name="Ferguson" />===		===Severity (Berlin Definition)<ref name="Ferguson" /> Ferguson ND et. al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012 Oct;38(10):1573-82.</ref>===
	{\| class="wikitable"		{\| class="wikitable"
	\| align="center" style="background:#f0f0f0;"\|'''PaO2/FiO2'''		\| align="center" style="background:#f0f0f0;"\|'''PaO2/FiO2'''

Rossdonaldson1: /* Background */

2024-04-24T18:38:25Z

Background

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	==Background==		==Background==
			[[File:Lung and diaphragm.jpg\|thumb\|Lobes of the lung with related anatomy.]]
	*Non-cardiogenic [[pulmonary edema]] due to lung capillary endothelial injury (diffuse alveolar damage)		*Non-cardiogenic [[pulmonary edema]] due to lung capillary endothelial injury (diffuse alveolar damage)
	**Proteinaceous material accumulate in alveoli in a heterogeneous manner (hyalinosis)		**Proteinaceous material accumulate in alveoli in a heterogeneous manner (hyalinosis)

Elcatracho: /* Additional Ventilation Considerations */

2022-11-01T15:52:46Z

Additional Ventilation Considerations

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	*Permissive hypercapnia		*Permissive hypercapnia
	*Maintain plateau pressures < 30 <ref>Hansen-Flaschen et al. Acute respiratory distress syndrome: Clinical features and diagnosis.UpToDate accessed 3/26/14</ref>		*Maintain plateau pressures < 30 <ref>Hansen-Flaschen et al. Acute respiratory distress syndrome: Clinical features and diagnosis.UpToDate accessed 3/26/14</ref>
			**Driving pressure (plateau pressure minus PEEP) <14 is most strongly associated with decreased mortality<ref>Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747-755. doi:10.1056/NEJMsa1410639</ref>
	*Ensure adequate [[sedation]]		*Ensure adequate [[sedation]]
	**Better synchrony with vent		**Better synchrony with vent

Elcatracho: /* Causes */

2022-10-04T22:10:16Z

Causes

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	===Causes===		===Causes===
			*[[Pneumonia]]
	*[[Sepsis]]		*[[Sepsis]]
	*[[Pancreatitis]]		*[[Pancreatitis]]

Elcatracho: /* Differential Diagnosis */

2021-05-22T23:08:51Z

Differential Diagnosis

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	*[[DIC]]		*[[DIC]]
	*[[CHF]]		*[[CHF]]
	*[[High altitude pulmonary edema]]

	{{Pulmonary edema types}}		{{Pulmonary edema types}}