Intensive Care Medicine

, Volume 45, Issue 4, pp 516–519 | Cite as

Acute respiratory distress syndrome (ARDS) phenotyping

  • M. Shankar-HariEmail author
  • E. Fan
  • N. D. Ferguson
Understanding the Disease

Clinically, the Berlin ARDS definition describes acute respiratory distress syndrome (ARDS) as acute hypoxaemic respiratory failure that is not fully explained by cardiac failure or fluid overload, that develops within 7 days of clinical recognition of a known risk factor, with bilateral radiographic opacities that are not fully explained by effusions, lobar/lung collapse, or nodules. Three risk strata were defined on the basis of the severity of hypoxaemia represented by the ratio of partial pressure of oxygen in arterial blood to inspired oxygen concentration (PaO2/FiO2 ratio), assessed at a minimum positive end-expiratory pressure (PEEP) of 5 cmH2O [1]. Hospital mortality worsens with severity of hypoxaemia and thus grade of ARDS (from 35% in mild ARDS to 46% in severe ARDS) [1, 2].

The ARDS consensus definitions to date have mainly relied on feasible clinical criteria, which helps to group patients together for inclusion in clinical trials and for clinical management [1, 3]. This...



This independent research by Dr Manu Shankar-Hari is supported by the National Institute for Health Research Clinician Scientist Award (NIHR-CS-2016-16-011). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

Author contributions

Dr Shankar-Hari wrote the first draft of the manuscript. All authors contributed towards the critical revision of the manuscript for important intellectual content and confirm the integrity of the work.


Dr Shankar-Hari is supported by the National Institute for Health Research Clinician Scientist Award (CS-2016-16-011). Dr Fan is supported by a New Investigator Award from the Canadian Institutes of Health Research.

Compliance with ethical standards

Conflicts of interest

All authors declare that they do have any personal conflict of interest directly related to this manuscript.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Immunology and Microbial ScienceKings College LondonLondonUK
  2. 2.Guy’s and St Thomas’ NHS Foundation Trust, ICU Support OfficesSt Thomas’ HospitalLondonUK
  3. 3.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  4. 4.University Health Network and Sinai Health SystemTorontoCanada

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