New Respiratory and Hemodynamic Strategies of the Revised Berlin Definitions of the Acute Respiratory Distress Syndrome

L.O. Maltseva, M.F. Mosentsev, O.A. Mishchenko, A.V. Borzova, M.M. Perederii


This article presents an overview and analysis of the new respiratory and hemodynamic strategies of the revised Berlin definitions of the acute respiratory distress syndrome (ARDS) on the basis of the researches published from 2011 to present: re-structured definition of acute respiratory distress syndrome; inclusion in the diagnostic criteria for the management of regression of noninvasive surrogate SF indicator; cha­racteristics of the structural changes in the lungs in mechanical ventilation (MV); the introduction of the term «respiratory lungs»; criteria of the feasibility of including «respiratory lungs» tactics; predictors of noninvasive MV failure; assessment of the lung recruitability; statement that ultraprotective strategy for MV with low-flow CO2 improves clinical outcomes in patients with moderate ARDS; the correlation between the time of intubation and the percentage of mortality; evaluating the effectiveness of conservative and liberal oxygenation strategy; multivariate analysis of the relationship of conservative and li­beral versions of infusion therapy for ARDS, the initial central venous pressure and disease outcome; feasibility of using isolated veno-venous or veno-arterial extracorporeal membrane oxygenation in ARDS and refractory septic shock, and determining the advantages of VVA-modification; description of Lung Injury Prediction Score; methods of ARDS prevention in high risk patients.


acute respiratory distress syndrome; basic strategies; revision


Chiumello D., Coppola S. Nonintubated Patients with Acute Respiratory Distress Syndrome: A Watchful Evaluation // Journal Critical Care Med. — 2016. — ​Vol. 44, iss. 1. — ​Р. 246-247.

Festic E., Bansal V., Kor D.J., Cajic O., Illness USC Injury Trials Group, Lung Injury Prevention Study 1 (2015). SpO2/FiO2 Ratio on hospital Admission is on Indicator of Early Acute Respiratory Distress Syndrome Development Among Patients at Risk // J. Intensive Care Med. — 2015. — ​Vol. 30. — ​P. 209-216.

Serpa Neto A., Cardoso S.O., Ong D.S., Esposito D.C. et al. The use of the pulse oximetric saturation/fraction of inspired oxygen ratio for risk stratification of patients with severe sepsis and septic shock // Journal of Critical Care. — 2013. — ​Vol. 18. — ​P. 681-686.

Slutsky A.S., Raniery V.M. Ventilator-Inducted Lung Injury // N. Engl. J. Med. — 2013. — ​Vol. 369. — ​P. 2126-2136.

Lorente J.A. et al. Acute respiratory distress syndrome: does histology matter? // Crit. Care. — 2015. — № 19. — ​P. 337.

Kacmarek R.M., Villar J., Sulemanji D., Montiel R. et al. Open Lung Approach for the Acute Respiratory Distress Syndrome: A Pilot, Randomized Controlled Trial // Journal of Critical Care Med. — 2015. — ​Vol. 44, iss. 1. — ​P. 32-42.

Okamoto K. Permissive hypoxemia: another strategy // Journal of the Japanese Society of Intensive Care Medicine. — 2016. — ​Vol. 23, № 2. — ​P. 113-116.

Chawla R., Mansuriya J., Modi N., Pandey A. et al. Acute respiratory distress syndrome: Predictor of noninvasive ventilation fai­lure and intensive care unit mortality in clinical practice // Journal of Critical Care. — 2016. — ​Vol. 31, iss. 1. — ​P. 26-30.

Sehgal J.S., Dhooria S., Agarwal R., Chaudhty D. Noninvasive ventilation in acute respiratory distress syndrome: A long way ahead // Journal of Critical Care Med. — 2016. — ​Vol. 20, iss. 2. — ​P. 129-130.

Guillaume C. et al. Failure of Noninvasive Ventilation for De Novo Acute Hypoxemic Respiratory Failure: Role of Tidal Volume // Journal of Critical Care Med. — 2016. — ​Vol. 20, iss. 2. — ​P. 282-290.

Kangelaris K.N., Ware L.B., Wang Ch.J., Janz D.K. et al. Timing of Intubation and Clinical Outcomes in Adults with Acute respiratory Distress Syndrome // Journal of Critical Care Med. — 2016. — ​Vol. 44, iss. 1. — ​P. 120-129.

Caironi P., Carlesso E., Cressoni M., Chiumello D. et al. Lung Recruitability is Better Estimated ed According to the Berlin Definition of Acute Respiratory Distress Syndrome at Standard 5 cm H2O rather Than Higher Positive End-Expiratory pressure. Retrospective Cohort Study // Journal of Critical Care Med. — ​Vol. 43, iss. 4. — ​P. 781-790.

Fanelli V., Ranieri M.V., Mancebo J., Moerer O. et al. Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress syndrome // Crit. Care — ​2016. — ​Vol. 20. — ​P. 36.

Panwar R., Hardil M., Bellomo R., Barrof L. et al. Conservative versus Liberal Oxygenation Targets for Mechanically Ventilated Patients. A Pilot Multicenter Randomized Controlled Trail // Am. J. of Resp. and Crit. Care Med. — 2016. — ​Vol. 193, № 1. — ​P. 43-51.

Pannu S.R., Dziadzko M.A., Gajic O. How Much Oxygen? Oxygen Titration Goals during Mechanical Ventilation // Am. J. of Resp. and Crit. Care Med. — 2016. — ​Vol. 193, № 1. — ​P. 4-5.

Claesson J., Freundlich M., Gunnarsson J., Laake J.H. et al. Scandinavian clinical practice guideline on mechanical ventilation in adults with the acute respiratory distress syndrome // Acta Anaesthesiologica Scandinavica. — 2015. — ​Vol. 59, iss. 3. — ​P. 286-297.

Waechter J., Kumar A., Lapinsky S.E., Marshall J. et al. Interaction Between Fluid and Vasoactive Agents on Mortality in Septic shock. A Multicenter, Observational Study // Journal of Critical Care Med. — 2014. — ​Vol. 42, iss. 10. — ​P. 2158-2168.

Grissom C.K., Hirshberg E.L., Dickerson J.B., Brown S.M. et al. Fluid Management with a Simplified Conservative Protocol for the acute Respiratory Distress Syndrome // Jounal of Crit. Care Med. — 2015. — ​Vol. 43, iss. 2. — ​P. 288-295.

Semler M.W., Wheeler A.P., Thompson R.T., Bernard G.R. et al. Impact of Initial Central Venous Pressure on outcomes of conservative Versus Liberal Fluid Management in Acute Respiratory Distress Syndrome // Journal of Critical Care Med. — 2016. — ​Vol. 44, iss. 4. — ​P. 782-789.

Mikacenic C., Hansen E., Radelld F., Gharib S.A. et al. Interleukin‑17A is Associated with Alveolar Inflammation and Poor outcomes on Acute Respiratory Distress Syndrome // Journal of Critical Care Med. — 2016. — ​Vol. 44, iss. 3. — ​P. 496-502.

Ongl D.S., Spitoniy C., Kllin F.M. et al. Cytomegalovirus reactivation and mortality in patients with acute respiratory distress syndrome // Intensive Care Med. — 2016. — ​Vol. 42, iss. 3. — ​P. 333-341.

Hye J.J., Doosoo J., Tun S.K., Woo H.Ch. et al. Veno-veno-arterial extracorporeal membrane oxygenation treatment in patients with several acute respiratory distress syndrome and septic shock // Crit. Care. — 2016. — ​Vol. 20. — ​P. 28.

Mosier J.M., Kelsey M. et al. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department in the emergency department: history, current applications, and future directions // Crit. Care. — 2015. — № 19. — ​P. 431.

Brower R.G., Antonelli M. What’s new in ARDS: can we prevent it? // Intensive Care Med. — 2016; DOI: 10.1007/s00134-016-4280-0.

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