How is acute respiratory distress syndrome (ARDS) characterized in coronavirus disease 2019 (COVID-19)?

Updated: Jan 12, 2021
  • Author: Setu K Patolia, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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ARDS is a feared complication of COVID-19. ARDS is defined by the Berlin criteria by the presence of acute hypoxic respiratory failure with bilateral infiltrates without a known etiology in the presence of a known insult within 7 days. Hypoxia is graded in these patients by the means of a PaO2/FiO2 ratio, which is the ratio of the partial pressure of arterial oxygen divided by the fraction of oxygen inspired. [12] Although not included in the definition, decreased lung compliance, calculated as the tidal volume divided by the plateau pressure minus the positive end-expiratory pressure, is a prominent feature. However, initial reports from Italy seem to suggest an atypical form of ARDS in patients with COVID-19. In an editorial report of 16 patients with ARDS secondary to COVID-19, the respiratory lung compliance was 50 ±14.3 mL/H2O but with significant hypoxia as evidenced by a shunt fraction of 0.50 ±0.11. [13]

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