Table 3.
Current ARDS criteria and future direction.
| Current Berlin criteria (7) (2012) |
Short-term possible revisions (2023+) (19) | Future areas of research (onwards) (19) |
|
|---|---|---|---|
| Timing | Acute onset (<1 week) | Methodologies (big data, systems biology, multiomics, biomarker development, and point-of-care testing development, etc.) addressing the dynamic and complex interaction between risk factors, phenotypes, endotypes, and expression modulators to facilitate the development of precision medicine through the endotype-/theratype-driven approach | |
| Hypoxemia | The Berlin definition: PaO2/FiO2 ≤ 300 Mild: ≤ 201-300 (PaO2/FiO2) Moderate: ≤ 101-200 (PaO2/FiO2) Severe: ≤ 100 (PaO2/FiO2) |
SpO2/FiO2 ratio | |
| PEEP | ≥ 5 cmH2O | High-flow nasal oxygen, no requirement for minimum PEEP | |
| Chest imaging | Bilateral infiltrates (chest X-ray or CT scan) | Ultrasound | |
| Origin of edema | Not fully explained by cardiac failure | ||
|
New methodologies
• Biomarkers (plasma and BALF) ( 20–23) ➢ Inflammation (IL-6, IL-8, sTNF-R1, IL-1β, IL-1R, IL-18, HMGB1, NETs, C3a, C4d, C5a, C5b-9, Bb) ➢ Epithelium (RAGE, SP-D, KL-6, CC16) ➢ Endothelium (vWF, Ang-2, ICAM-1; syndecan, endocan) ➢ Coagulation/fibrinolysis (protein C, PAI-1, TM) ➢ Apoptosis (Fas and Fas-L) ➢ Fibrogenesis (laminin, elastin, desmosine, MMPs) • Multiomics • Systems biology • Multiplexed point-of-care testing |
None | None |
Ang-2, angiopoietin 2; BALF, bronchoalveolar lavage fluid; CC16, Clara cell secretory protein; Fas, tumor necrosis factor receptor superfamily member 6; Fas-L, Fas ligand; HMGB1, high mobility group box nuclear protein 1; PaO2, partial pressure artery oxygen; FiO2, fraction of inspired oxygen; ICAM-1, intercellular adhesion molecule 1; IL, interleukin; IL-1RA, interleukin-1 receptor antagonist; KL-6, Krebs von den Lungen-6; NETs, neutrophil extracellular traps; PAI-1, plasminogen activator inhibitor 1; PEEP, positive end-expiratory pressure; RAGE, receptor of advanced glycation end products; SP-D, surfactant protein D; SpO2, oxygen saturation; sTNF-R, soluble tumor necrosis factor receptor; TM, thrombomodulin; TNF, Tumor necrosis factor; vWF, von Willebrand factor.