Berlin Criteria for ARDS
2012 Berlin Definition of ARDS. Classifies severity by PaO₂/FiO₂ ratio with PEEP ≥ 5 cmH₂O.
Score interpretation
Does not meet Berlin criteria for ARDS. Consider alternative diagnosis.
→ Investigate for pneumonia, cardiac pulmonary oedema, PE, or atelectasis. Echocardiography to exclude cardiogenic cause.
Berlin Mild ARDS. PaO₂/FiO₂ 201–300 on PEEP ≥ 5. 28-day mortality ~27%.
→ ICU admission. Lung-protective ventilation: TV 6 mL/kg IBW, plateau pressure < 30 cmH₂O. PEEP titration (ARDSNet table). Prone positioning if P/F < 150 after 12–24h. Daily SBT. Treat underlying cause.
Berlin Moderate ARDS. PaO₂/FiO₂ 101–200. 28-day mortality ~32%.
→ Lung-protective ventilation (TV 4–6 mL/kg IBW). Higher PEEP strategy. Prone positioning ≥ 16h/day (PROSEVA protocol). NMB if dyssynchrony. Consider VV-ECMO referral if refractory.
Berlin Severe ARDS. PaO₂/FiO₂ ≤ 100. 28-day mortality ~45%.
→ Immediate ICU / ECMO centre discussion. Prone positioning ≥ 16h/day. NMB (cisatracurium). Permissive hypercapnia (pH ≥ 7.20). VV-ECMO if P/F < 80 after optimisation. Daily reassessment of ECMO criteria.
Interpretation bands for the Berlin ARDS. Apply clinical judgement and local guidance.
References
- ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012.
- Guérin C et al. Prone positioning in severe acute respiratory distress syndrome (PROSEVA). N Engl J Med. 2013.
Related
Curated clinical cross-links plus same-class fallbacks.
- Withdrawal Assessment Tool (WAT-1) for Paediatric Iatrogenic Withdrawal · Critical Care
- Oxygenation Index (OI) · Critical Care
- Paediatric Early Warning Score (PEWS) · Critical Care
- Paediatric Fluid Resuscitation Calculator · Critical Care
- Paediatric Index of Mortality 3 (PIM3) · Critical Care
- Berlin Criteria for Acute Respiratory Distress Syndrome (ARDS) · Critical Care
- 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.