New Global Definition of ARDS (2024)
The new global definition of ARDS (Matthay and colleagues, AJRCCM 2024), the successor to the 2012 Berlin definition.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Category
- Invasively ventilated. A minimum PEEP of 5 cm H2O is required for…
- Criterion applying to ALL categories. An acute predisposing risk factor is present
- Yes
- Criterion applying to ALL categories. Edema is not exclusively or primarily…
- Yes
- Criterion applying to ALL categories. Onset or worsening of hypoxemic…
- Yes
- Criterion applying to ALL categories. Bilateral opacities on radiography or CT
- Yes
- INTUBATED ONLY
- Yes
- Which oxygenation ratio
- PaO2:FiO2
- The oxygenation ratio value
- 150 ratio
Result: severity moderate
The tool opens with these values already filled in. Replace them with your own.
What the result means
- All categories
- Risk factor; edema not primarily cardiogenic; within 1 week; bilateral opacities.
- Nonintubated
- HFNO 30 L/min or more, or NIV/CPAP 5 cm H2O or more. NO SEVERITY GRADE EXISTS here.
- Intubated mild
- PaO2:FiO2 above 200 to 300, or SpO2:FiO2 above 235 to 315. Needs PEEP 5 or more.
- Intubated moderate
- PaO2:FiO2 above 100 to 200, or SpO2:FiO2 above 148 to 235.
- Intubated severe
- PaO2:FiO2 100 or below, or SpO2:FiO2 148 or below.
- Resource-limited
- SpO2:FiO2 315 or below. NO PEEP or flow requirement, and NO severity grade. A different denominator.
- SpO2 gate
- The saturation ratio is INVALID above SpO2 97%. Do not compute it there.
- Corrections
- Estimated FiO2 = ambient + 0.03 x L/min. Above 1000 m, multiply the ratio by barometric pressure / 760.
- Scope
- A definition, not a severity score or prognostic model. Does not identify the cause or indicate any intervention.
What you enter
- Category.
- Criterion applying to ALL categories.
- Criterion applying to ALL categories.
- Criterion applying to ALL categories.
- Criterion applying to ALL categories.
- INTUBATED ONLY.
- NONINTUBATED ONLY.
- Which oxygenation ratio.
The other 2 fields
- Category. Decides whether a severity grade exists at all: ONLY the intubated category is graded [nonintubated = On high-flow nasal oxygen at 30 L/min or more, or noninvasive ventilation or CPAP with at least 5 cm H2O end-expiratory pressure. intubated = Invasively ventilated. A minimum PEEP of 5 cm H2O is required for every severity category. resource-limited = Neither positive end-expiratory pressure nor a minimum oxygen flow rate is required, and only the saturation ratio is used.]
- Criterion applying to ALL categories. An acute predisposing risk factor is present (pneumonia, nonpulmonary infection, trauma, transfusion, burn, aspiration, or shock)
- Criterion applying to ALL categories. Edema is not exclusively or primarily attributable to cardiogenic pulmonary edema or fluid overload, and hypoxemia is not primarily attributable to atelectasis
- Criterion applying to ALL categories. Onset or worsening of hypoxemic respiratory failure within 1 week of the risk factor or of new or worsening respiratory symptoms
- Criterion applying to ALL categories. Bilateral opacities on radiography or CT, or bilateral B lines and/or consolidations on ultrasound, not fully explained by effusions, atelectasis, or nodules/masses
- INTUBATED ONLY. Whether PEEP is at least 5 cm H2O. Required for EVERY intubated severity category; severity is not read off the ratio alone.
- NONINTUBATED ONLY. Whether the patient is on high-flow nasal oxygen at 30 L/min or more, or NIV/CPAP with at least 5 cm H2O end-expiratory pressure.
- Which oxygenation ratio. The resource-limited category accepts SpO2:FiO2 ONLY [pf = PaO2:FiO2; sf = SpO2:FiO2]
- The oxygenation ratio value. Apply the altitude correction first if above 1,000 m.
- Oxygen saturation. REQUIRED when using SpO2:FiO2, because the ratio is INVALID above 97 percent and the tool refuses to assess there.
How this is calculated
Matthay MA, Arabi Y, Arroliga AC, et al. A New Global Definition of Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2024;209(1):37-47. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.