title: Acute Respiratory Distress Syndrome in Burn Patients: A Comparison of the Berlin and American-European Definitions.
abstract: The purpose of this study was to compare the Berlin definition to the American-European Consensus Conference (AECC) definition in determining the prevalence of acute respiratory distress syndrome (ARDS) and associated mortality in the critically ill burn population. Consecutive patients admitted to our institution with burn injury that required mechanical ventilation for more than 24 hours were included for analysis. Included patients (N = 891) were classified by both definitions. The median age, % TBSA burn, and injury severity score (interquartile ranges) were 35 (24-51), 25 (11-45), and 18 (9-26), respectively. Inhalation injury was present in 35.5%. The prevalence of ARDS was 34% using the Berlin definition and 30.5% using the AECC definition (combined acute lung injury and ARDS), with associated mortality rates of 40.9 and 42.9%, respectively. Under the Berlin definition, mortality rose with increased ARDS severity (14.6% no ARDS; 16.7% mild; 44% moderate; and 59.7% severe, P < 0.001). By contrast, under the AECC definition increased mortality was seen only for ARDS category (14.7% no ARDS; 15.1% acute lung injury; and 46.0% ARDS, P < 0.001). The mortality of the 22 subjects meeting the AECC, but not the Berlin definition was not different from patients without ARDS (P = .91). The Berlin definition better stratifies ARDS in terms of severity and correctly excludes those with minimal disease previously captured by the AECC.
authors.affiliation: From the *San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas; †United States Army Institute of Surgical Research, Fort Sam Houston, San Antonia, Texas; ‡Uniformed Health Services University of the Health Sciences, Bethesda, Maryland; §David Grant Medical Center, Travis Air Force Base, California; and ‖University of Texas Health Sciences Center at San Antonio, Texas.
authors.forename: Christy R
authors.initials: CR
authors.lastname: Sine
authors.forename: Slava M
authors.initials: SM
authors.lastname: Belenkiy
authors.forename: Allison R
authors.initials: AR
authors.lastname: Buel
authors.forename: J Alan
authors.initials: JA
authors.lastname: Waters
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Lundy
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Henderson
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Stewart
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.forename: Nehemiah T
authors.initials: NT
authors.lastname: Liu
authors.forename: Andriy
authors.initials: A
authors.lastname: Batchinsky
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Cannon
authors.forename: Leopoldo C
authors.initials: LC
authors.lastname: Cancio
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
mesh_terms: D055371:Acute Lung Injury / Q000175:diagnosis* / Q000209:etiology; D000328:Adult; D002056:Burns / Q000150:complications*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*