What are the classifications of acute respiratory distress syndrome (ARDS) in sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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In 1994, the American-European Consensus Conference on ARDS agreed on standard definitions of ALI and ARDS. [9] However, these definitions were subsequently replaced by the following consensus, referred to as the Berlin Definition of ARDS, which essentially does away with the classification of ALI in favor of classifying ARDS as mild, moderate, or severe [10] :

  • Mild ARDS – An oxygenation abnormality with a PaO2/FIO2 ratio of 200-300 and a positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) of 5 cm water or higher

  • Moderate ARDS – A PaO2/FIO2 ratio of 100-200 and a PEEP of 5 cm water or higher

  • Severe ARDS – A PaO2/FIO2 ratio of 100 or less and a PEEP of 5 cm water or higher

  • Bilateral opacities on chest radiographs that are not fully explained by effusions, lobar/lung collapse, or nodules

  • Edema not of cardiac origin or caused by fluid overload – In the absence of risk factors for ARDS, this requires objective assessment (eg, via echocardiography)

  • Occurrence within 1 week of a known clinical insult or worsening respiratory symptoms

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