Berlin ARDS Criteria

How to use it

1. 1

   All 4 qualitative criteria must be met. Acute onset, bilateral infiltrates, not CHF-explained, PEEP ≥5.

2. 2

   PF ratio classifies severity. Mild 200–300, moderate 100–199, severe <100.

3. 3

   Exclude cardiogenic oedema. Echo + BNP if uncertain; ARDS can coexist with CHF.

When to use it

Mechanical ventilation — protective strategy

TV 6 mL/kg IBW, Pplat ≤30 cmH₂O, PEEP titration.

Prone positioning

Severe ARDS PF <150 on FiO₂ ≥0.6: prone ≥16h/day.

ECMO referral

PF <80 after optimal ventilation >6h: refer to ECMO centre.