Murray Score for Acute Lung Injury (ALI/ARDS)
Quantifies the severity of acute lung injury / ARDS from 4 parameters (Murray 1988). A score above 3.0 despite optimal conventional management was the CESAR criterion for referral to an ECMO centre.
Score interpretation
Murray Score 0: No acute lung injury.
→ No specific intervention. Treat underlying cause. Lung-protective ventilation if intubated.
Murray Score 0.1–2.5: mild to moderate lung injury.
→ Lung-protective ventilation (TV 6 mL/kg IBW, PEEP titration). Treat underlying cause. Daily SOFA. Prone if P/F < 150 not improving.
Murray Score above 2.5: severe lung injury.
→ Optimise lung-protective ventilation (6 mL/kg IBW, PEEP titration, prone positioning, neuromuscular blockade per local protocol). Discuss early with the regional ECMO centre if not improving.
Murray Score above 3.0 despite optimal conventional management: the CESAR criterion for referral to an ECMO centre (Peek 2009).
→ Refer urgently to the ECMO centre if the cause is potentially reversible. Continue lung-protective ventilation. Involve a senior intensivist.
Interpretation bands for the Murray Score. Apply clinical judgement and local guidance.
References
- Murray JF, et al. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988;138(3):720–723.
- Peek GJ, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351–1363.
Related
Curated clinical cross-links plus same-class fallbacks.
- Dobutamine (Acute HF / Stress Echo) · Inotrope / Acute Heart Failure
- Milrinone · Inodilator / Acute Heart Failure
- Poractant Alfa (Porcine Surfactant) · Lung Surfactant (Respiratory Distress Syndrome — Neonatal)
- Mannitol (Osmotic Diuretic — Renal/Neurological) · Acute Oliguric Renal Failure / Raised ICP
- Dexamethasone (ICU / ARDS) · Systemic Corticosteroid
- Doxapram hydrochloride · Respiratory stimulant
- Acute Asthma in Adults · BTS/SIGN British Guideline on Asthma 2019; NICE NG80
- Pulmonary Embolism Assessment · NICE NG158; ESC 2019 PE Guidelines
- Acute Exacerbation of COPD (AECOPD) · NICE NG115; GOLD 2024
- Spontaneous Pneumothorax (Adult) · BTS Pleural Disease 2023
- Atypical Pneumonia (Legionella / Mycoplasma / Chlamydophila) · BTS 2023; IDSA
- COPD Exacerbation Management · NICE NG115 / GOLD 2024
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.