急性呼吸窘迫综合征(ARDS)柏林标准
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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 withPEEP or CAPA≥5cmH2O
中度
100 mmHg <PaO2/FiO2≤200mmHg with PEEP≥5cmH2O
重度
PaO2/FiO2≤100mmHg with PEEP ≥ 5cmH2O
误解201-300mmHg为ALI
氧合指数
PaO2/FiO2≤200mmHg，未考虑PEEP水平
不同的PEEP及FiO2，
PaO2/FiO2也不同
胸片
双肺弥漫性浸润
缺乏客观评价指标
PAWP
PAWP≤18mmHg,无左心房高压
ARDS及高水平PAWP可同时存在，PAWP有不确定性
危险因素
无
未考虑
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 PaO2/FiO2<300mmHg
Misinterpreted as PaO2/FiO2=201-300,leading to confusing ALI/ARDS term
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
AECC标准
AECC局限性
病程：
急性起病
无具体时间
ALI
PaO2/FiO2≤300mmHg
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
3 Mutually exclusive subgroups of ARDS by severity
ALI term removed
oxygenation
PaO2/FiO2<300mmHg(regardless of PEEP)
Inconsistency of PaO2/FiO2ration due to the effect of PEEP and/or FiO2
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
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
急性呼吸窘迫综合征(ARDS)柏林标准
全网发布：2012-07-24 21:50发表者：徐大林(访问人次：2566)
发病时间
1周以内起病、或新发、或恶化的呼吸症状
胸部影像学庐江县人民医院呼吸内科徐大林
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.
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
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
Moderate
100mmHg< PaO2/FiO2≤200mmHg with PEEP≥5c0mmHg with PEEP≥5cmH2O
Berlin标准的有效性
Berlin：1. ARDS严重程度越高，死亡率越高
2. ARDS严重程度越高，脱离呼吸机时间越短
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
3. ARDS严重程度越高，呼吸机使用时间越长
比较AECC标准，Berlin能更有效、细化ARDS的严重程度，为ARDS的诊断及预后划定标准。
1994年欧美会议共识（AECC）ARDS诊断标准：
1.病程：急性起病
2.低氧血症：PaO2/FiO2≤200mmHg
3.胸片：双肺弥漫性浸润
4.没有左心房高压的证据，PAWP≤18mmHg
ALI诊断标准: PaO2/FiO2≤300mmHg
1967年Ashbaugh第一次提出了成人呼吸窘迫综合征
1.呼吸频率增快
2.低氧血症
3.肺顺应性下降
4.常规呼吸支持治疗效果较差
AECC标准
The Berlin Definition
病程：
急性起病
确定具体时间
ALI
PaO2/FiO2≤300mmHg
氧合指数
轻度
200 mmHg <PaO2/FiO2≤300mmHg withPEEP or CAPA≥5cmH2O
中度
100 mmHg <PaO2/FiO2≤200mmHg with PEEP≥5cmH2O
重度
PaO2/FiO2≤100mmHg with PEEP ≥ 5cmH2O
误解201-300mmHg为ALI
氧合指数
PaO2/FiO2≤200mmHg，未考虑PEEP水平
不同的PEEP及FiO2，
PaO2/FiO2也不同
胸片
双肺弥漫性浸润
缺乏客观评价指标
PAWP
PAWP≤18mmHg,无左心房高压
ARDS及高水平PAWP可同时存在，PAWP有不确定性
危险因素
无
未考虑
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 PaO2/FiO2<300mmHg
Misinterpreted as PaO2/FiO2=201-300,leading to confusing ALI/ARDS term
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
AECC标准
AECC局限性
病程：
急性起病
无具体时间
ALI
PaO2/FiO2≤300mmHg
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
3 Mutually exclusive subgroups of ARDS by severity
ALI term removed
oxygenation
PaO2/FiO2<300mmHg(regardless of PEEP)
Inconsistency of PaO2/FiO2ration due to the effect of PEEP and/or FiO2
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
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
急性呼吸窘迫综合征(ARDS)柏林标准
全网发布：2012-07-24 21:50发表者：徐大林(访问人次：2566)
发病时间
1周以内起病、或新发、或恶化的呼吸症状
胸部影像学庐江县人民医院呼吸内科徐大林
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.
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
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
Moderate
100mmHg< PaO2/FiO2≤200mmHg with PEEP≥5c0mmHg with PEEP≥5cmH2O
Berlin标准的有效性
Berlin：1. ARDS严重程度越高，死亡率越高
2. ARDS严重程度越高，脱离呼吸机时间越短
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
3. ARDS严重程度越高，呼吸机使用时间越长
比较AECC标准，Berlin能更有效、细化ARDS的严重程度，为ARDS的诊断及预后划定标准。
1994年欧美会议共识（AECC）ARDS诊断标准：
1.病程：急性起病
2.低氧血症：PaO2/FiO2≤200mmHg
3.胸片：双肺弥漫性浸润
4.没有左心房高压的证据，PAWP≤18mmHg
ALI诊断标准: PaO2/FiO2≤300mmHg
1967年Ashbaugh第一次提出了成人呼吸窘迫综合征
1.呼吸频率增快
2.低氧血症
3.肺顺应性下降
4.常规呼吸支持治疗效果较差
AECC标准
The Berlin Definition
病程：
急性起病
确定具体时间
ALI
PaO2/FiO2≤300mmHg