@article{oai:nagasaki-u.repo.nii.ac.jp:00006890,
 author = {Kushimoto, Shigeki and Endo, Tomoyuki and Yamanouchi, Satoshi and Sakamoto, Teruo and Ishikura, Hiroyasu and Kitazawa, Yasuhide and Taira, Yasuhiko and Okuchi, Kazuo and Tagami, Takashi and Watanabe, Akihiro and Yamaguchi, Junko and Yoshikawa, Kazuhide and Sugita, Manabu and Kase, Yoichi and Kanemura, Takashi and Takahashi, Hiroyuki and Kuroki, Yuuichi and Izumino, Hiroo and Rinka, Hiroshi and Seo, Ryutarou and Takatori, Makoto and Kaneko, Tadashi and Nakamura, Toshiaki and Irahara, Takayuki and Saito, Nobuyuki},
 issue = {4},
 journal = {Critical Care},
 month = {Jun},
 note = {Introduction: The Berlin definition divides acute respiratory distress syndrome (ARDS) into three severity categories. The relationship between these categories and pulmonary microvascular permeability as well as extravascular lung water content, which is the hallmark of lung pathophysiology, remains to be elucidated. The aim of this study was to evaluate the relationship between extravascular lung water, pulmonary vascular permeability, and the severity categories as defined by the Berlin definition, and to confirm the associated predictive validity for severity.Methods: The extravascular lung water index (EVLWi) and pulmonary vascular permeability index (PVPI) were measured using a transpulmonary thermodilution method for three consecutive days in 195 patients with an EVLWi of ≥10 mL/kg and who fulfilled the Berlin definition of ARDS. Collectively, these patients were seen at 23 ICUs. Using the Berlin definition, patients were classified into three categories: mild, moderate, and severe.Results: Compared to patients with mild ARDS, patients with moderate and severe ARDS had higher acute physiology and chronic health evaluation II and sequential organ failure assessment scores on the day of enrollment. Patients with severe ARDS had higher EVLWi (mild, 16.1; moderate, 17.2; severe, 19.1; P <0.05) and PVPI (2.7; 3.0; 3.2; P <0.05). When categories were defined by the minimum PaO2/FIO2ratio observed during the study period, the 28-day mortality rate increased with severity categories: moderate, odds ratio: 3.125 relative to mild; and severe, odds ratio: 4.167 relative to mild. On independent evaluation of 495 measurements from 195 patients over three days, negative and moderate correlations were observed between EVLWi and the PaO2/FIO2ratio (r = -0.355, P<0.001) as well as between PVPI and the PaO2/FIO2ratio (r = -0.345, P <0.001). ARDS severity was associated with an increase in EVLWi with the categories (mild, 14.7; moderate, 16.2; severe, 20.0; P <0.001) in all data sets. The value of PVPI followed the same pattern (2.6; 2.7; 3.5; P <0.001).Conclusions: Severity categories of ARDS described by the Berlin definition have good predictive validity and may be associated with increased extravascular lung water and pulmonary vascular permeability. Trial registration: UMIN-CTR ID UMIN000003627., Critical Care, 17(4), R132; 2013},
 title = {Relationship between extravascular lung water and severity categories of acute respiratory distress syndrome by the Berlin definition},
 volume = {17},
 year = {2013}
}