aPulmonary and Critical Care Department, University of São Paulo Medical School and Adult Intensive Care Unit, Albert Einstein Hospital bAbreu Sodré Intensive Care Unit and Servidor Público Estadual Hospital, São Paulo, São Paulo cUnimed Intensive Care Unit and Department of Internal Medicine, University Federal do Espírito Santo, Vitoria, Brazil.
Curr Opin Crit Care. 2014 Feb;20(1):10-6. doi: 10.1097/MCC.0000000000000058.
To analyze recently published articles in the medical literature that studied distinct aspects of adult patients with acute respiratory distress syndrome (ARDS) after the new Berlin definition introduced in 2012.
The degree of ARDS severity according to this new classification correlated well with extravascular lung water index, pulmonary vascular permeability index and the finding of diffuse alveolar damage on autopsy. The new possibility of bedside echocardiographic evaluation of biventricular cardiac function is indicating the necessity of including a subgroup of severity of patients with right ventricular dysfunction. High-resolution CT evaluation showed that signs of pulmonary fibroproliferation in early ARDS predict increased ventilator dependency, multiple organ failure and mortality. The median development of ARDS 1 or 2 days after hospital admission emphasizes the need for ARDS intrahospital prevention, especially protective ventilation in non-ARDS patients. The better outcome with the use of prone position in patients with PaO2/FIO2 below 150 recently observed questioned the Berlin definition thresholds to decide the future best treatment strategies according to the proposed degree of severity of the syndrome.
The impact of the Berlin definition of ARDS on the incidence, better treatment stratification and mortality ratio of ARDS is still to be determined.
分析 2012 年新柏林定义引入后，医学文献中关于急性呼吸窘迫综合征（ARDS）成年患者不同方面的研究。
根据这一新分类，ARDS 的严重程度与血管外肺水指数、肺血管通透性指数和尸检时弥漫性肺泡损伤的发现密切相关。新的床边超声心动图评估双心室心功能的可能性表明，有必要将右心室功能障碍患者的严重程度亚组包括在内。高分辨率 CT 评估显示，早期 ARDS 的肺纤维化增殖迹象预示着呼吸机依赖增加、多器官衰竭和死亡率增加。ARDS 在住院后 1 或 2 天发展中位数强调了 ARDS 院内预防的必要性，尤其是对非 ARDS 患者进行保护性通气。最近观察到 PaO2/FIO2 低于 150 的患者使用俯卧位治疗的效果更好，这对根据拟议的综合征严重程度决定未来最佳治疗策略的柏林定义阈值提出了质疑。
新柏林定义对 ARDS 的发病率、更好的治疗分层和死亡率的影响仍有待确定。
