Acute Lung Injury (ALI)?2005Delphi标准?2011Berlin DefinitionLancet. 1967; 2(7511):319-323Advantage 1.Simple and easy to use2.Differentiate ALI and ARDS没有体现ARDS本质(肺通透性增加、血管外肺水增多,肺炎症反应)诊断准确性不高We need a more accurate ALI/ARDS definitionPulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury. N Engl J Med 2006;354:2213-2429%ARDS患者PAWP≥18mmHg(或CVP升高), 而其中97%PAWP升高的ARDS患者中有正常或升高的心脏功能。结论:PAWP或CVP升高不能作为ARDS的排除标准。ARDS及高水平PAWP可同时存在,PAWP有不确定性Disadvantage 1.Acute onset:not defined2.PAOP:not measured3.pliance/MAP:not consideration4.Risk factors:not emphasizedJAMA, 2012 Jun 20;307(23):2526-33影像学改变:1.仍然认定双肺浸润改变诊断ARDS,可以行CT检查较胸片更准确;2.双肺透光度减弱,不能完全用胸腔积液,大叶/肺不张或结节病变解释的3.病变累及的范围(≥3/4肺野)可能作为重度ARDS诊断的附加标准1.不能完全由心力衰竭或容量过负荷解释的呼吸衰竭;2.如果没有ARDS的危险因素时可行超声心动图等检查排除静水压性肺水肿
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