A pre-definition was established51 and empirically evaluated using meta-analysis of data from 4,188 patients with ARDS from four different centers and physiological data of 269 patients with ARDS from three single centers. The pre-definition proposed three mutually

exclusive categories of ARDS based on the degree of hypoxemia: mild ARDS (200 mmHg < PaO2/FiO2 ≤ 300 mmHg), moderate ARDS (100 mmHg < PaO2/FiO2 ≤ 200 mmHg), and severe ARDS (PaO2/FiO2 ≤ 100 mmHg). Four auxiliary variables were proposed for the severe ARDS category: radiological www.selleckchem.com/products/dorsomorphin-2hcl.html severity; Csr (≤ 40 mL/cmH2O); PEEP (≥ 10 cm H2O); and corrected expired volume per minute (≥ 10 L/min). In the initial test of the proposal, the four auxiliary variables did not contribute to the validation of the predictive capacity of severe ARDS

regarding mortality and were then removed from the final criteria of the definition. Thus, the final definition was once again submitted to discussion and refined, until its publication. The literature Ulixertinib in vivo was reviewed to identify studies that met the following criteria: 1) large prospective studies involving multiple centers, including consecutive patients or randomized studies, or prospective studies from a single center with radiological or physiological data of adult patients with ALI/ARDS according to the criteria of the AECC; 2) studies to collect data needed to apply both the draft of the Berlin definition, as well as the definition of AECC; and 3) the authors of these studies were invited to participate and share data. The following variables were used in the analysis: hospital mortality or mortality at 90 days; number of days free of mechanical ventilation at 28 days after the ALI diagnosis; duration of mechanical ventilation in survivors, used as an indirect marker of the lung injury severity; and progression of ARDS severity at seven days, assessed using longitudinal data from patients. Radiologically, patients

with more extensive involvement (three to four quadrants) were differentiated Nabilone from those with mild lesions (two quadrants); static Crs complacency was calculated as tidal volume (in mL) divided by plateau pressure (cmH2O) subtracted from PEEP (cmH2O); the corrected expired volume per minute was calculated by the product of minute ventilation for PaCO2 divided by 40 mmHg;52 the total weight of the lung was calculated based on computed tomographic images;53 and the intrapulmonary shunt fraction was calculated as previously reported54 Table 3 shows the main limitations of AECC and the use of the corresponding measure adopted by the Berlin consensus to overcome the difficulties. The Berlin definition is shown in Table 4. The criteria for mild ARDS were met by 22% of patients (95% CI, 21%-24%), and these results were comparable with the diagnosis of ALI (not ARDS) of the AECC definition. 50% of patients (95% CI, 48%-51%) met the criteria for moderate ARDS and 28% (95% CI, 27%-30%) for severe ARDS.