Saturday, February 18, 2006


Saturday February 18, 2006
Delphi definition - new clinical definition of acute respiratory distress syndrome (ARDS)

Beside 2 definitions of ARDS used commonly - the American-European consensus conference definition and the lung injury score, a relatively new definiation - Delphi definition- developed and published last year in Journal of Critical Care and appears to have better specificity.

According to Delphi definition, ARDS is diagnosed if 1- 4 of below present with 5a and/or 5b:

1. PaO2/FiO2 ratio is less than or = 200 on PEEP more than or= 10.

2. Bilateral airspace disease on CXR.

3. Onset is within 72 hours.

4. No clinical evidence/subjective finding of CHF.

5a. Objective finding of non-cardiogenic edema (PWP less than or=18 or LVEF more than or=40%)

5b. Presence of risk factor for ARDS.

In one of the recent study where autopsy results were matched with clinical diagnoses to determine and compare the diagnostic accuracy of all three clinical definitions of ARDS, the specificity of the most commonly use, the American-European definition, was low.

References: Click to get article/abstract
1. Development of a clinical definition for acute respiratory distress syndrome using the Delphi technique. Volume 20, Issue 2, Pages 147-154 (June 2005) - caution of slow internet download
2. Acute respiratory distress syndrome: Underrecognition by clinicians and diagnostic accuracy of three clinical definitions. Critical Care Medicine: Volume 33(10) October 2005 pp 2228-2234