title: Diagnosing acute respiratory distress syndrome in resource limited settings: the Kigali modification of the Berlin definition.
abstract: OBJECTIVE
  The acute respiratory distress syndrome (ARDS) was re-defined by a panel of experts in Berlin in 2012. Although the Berlin criteria improved upon the validity and reliability of the definition, it did not make diagnosis of ARDS in resource limited settings possible. Mechanical ventilation, arterial blood gas measurements, and chest radiographs are not feasible in many regions of the world. In 2014, we proposed and applied the Kigali modification of the Berlin definition in a hospital in Rwanda. This review synthesizes literature from the last 18 months relevant to the Kigali modification.
  
  
  RESULTS
  In the last 18 months, the need for a universally applicable ARDS definition was reinforced by advances in supportive care that can be implemented in resource poor settings. Research demonstrating the variable impact of positive end expiratory pressure on hypoxemia, the validity of using pulse oximetry rather than arterial blood gas to categorize hypoxemia, and the accuracy of lung ultrasound support the use of the Kigali modification of the Berlin definition.
  
  
  CONCLUSIONS
  Studies directly comparing the Berlin definition to the Kigali modification are needed. Ongoing clinical research on ARDS needs to include low-income countries.
authors.affiliation: aDepartment of Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda bDivision of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA cDepartment of Anesthesia, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
authors.forename: Elisabeth D
authors.initials: ED
authors.lastname: Riviello
authors.forename: Egide
authors.initials: E
authors.lastname: Buregeya
authors.forename: Theogene
authors.initials: T
authors.lastname: Twagirumugabe
mesh_terms: D001604:Berlin; D006801:Humans; D010092:Oximetry; D011175:Positive-Pressure Respiration; D015203:Reproducibility of Results; D012128:Respiratory Distress Syndrome / Q000175:diagnosis*; D012432:Rwanda