Benefit of the application of new ARDS criteria (Berlin) compared to old criteria (AECC) in a tertiary hospital in a developing country

Background: There have been several ARDS definitions throughout years, including those by Laennec, Ausbagh, the Lung Injury score (LIS), and the American-European Consensus Conference (AECC) criteria in 1821, 1967, 1998, and 1994, respectively. In 2012, a new diagnostic criteria, the Berlin criteria, was published. Objective: To identify benefits of implementing the Berlin criteria as compared to the AECC criteria in a tertiary hospital of a developing country Method: This is a prospective, observational study conducted at a tertiary hospital in Jakarta from October 2015 to June 2016. Data was collected from ARDS patients in the emergency room, ICU, resuscitation room, and in-patient ward. Result: There were 104 ARDS patients according to the Berlin criteria, while only 75 patients were diagnosed as ARDS according to the AECC criteria. Both criteria showed that majority of the patients were male; the APACHE score was <20; the Charlson comorbidity index 2; and sepsis was the most common etiology. Seven-day survival was higher in the Berlin criteria (51.9%) than in the AECC criteria (48%). Conclusion: Application of the Berlin criteria in developing countries is more beneficial compared to the AECC criteria as a larger number of ARDS patients can be diagnosed, earlier diagnosis leads to earlier management thus increasing the survival rate, and excluding the use of a pulmonary artery catheter to measure the pulmonary wedge pressure.