Acute, diffuse inflammatory lung injury with bilateral infiltrates and PaO₂/FiO₂ ≤300 mmHg (Berlin definition).
Causes
- • Pneumonia, aspiration
- • Sepsis
- • Trauma, transfusion (TRALI)
- • Pancreatitis, drowning
Clinical features
- • Acute dyspnoea (<1 week)
- • Hypoxaemia
Investigations
- • ABG
- • CXR / CT: bilateral infiltrates
- • Echo to exclude cardiogenic
- • Sepsis workup
Diagnosis
- • Berlin: mild 200–300, mod 100–200, severe ≤100 mmHg
Differential diagnosis
- • Cardiogenic pulmonary oedema
- • Bilateral pneumonia
- • Diffuse alveolar haemorrhage
Management
- • Treat underlying cause
- • Lung-protective ventilation: Vt 6 mL/kg PBW, Pplat <30, PEEP ladder
- • Prone positioning >12 h if P/F <150
- • Conservative fluids
- • Neuromuscular blockade in severe
- • ECMO if refractory
Drug therapy
- • Dexamethasone 6 mg OD × 10 days (COVID-ARDS)
- • Avoid routine steroids otherwise
Complications
- • VILI, barotrauma
- • VAP
- • ICU-acquired weakness
- • PTSD
Clinical pearls
- • Driving pressure (Pplat–PEEP) <15 strongly correlates with survival
Related in WardRound
Educational — verify locally.
