At what Berlin ARDS severity does escalation therapy become indicated?

Mild ARDS (P/F 200-300): optimize PEEP, consider NIV. Moderate ARDS (P/F 100-200): prone positioning if P/F =16h/day, 48h NMB, early ECMO center referral if P/F remains <80 despite above measures.

How does rescue therapy differ for moderate vs severe ARDS?

Moderate (P/F 100-150): prone positioning, high PEEP, NMB, lung recruitment maneuvers. Severe (P/F <100): all of the above plus inhaled nitric oxide (bridge to ECMO), high-frequency oscillatory ventilation (HFOV, controversial after OSCILLATE trial), ECMO (EOLIA trial: 28-day mortality trend favoring ECMO). Each escalation step should be tried before the next.

ARDS Berlin Severity Stratification Tool

Stratify ARDS severity using Berlin 2012 P/F ratio thresholds combined with PEEP requirement and clinical trajectory to determine escalation to prone positioning, ECMO referral, and paralytic agent use.

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Frequently Asked Questions

At what Berlin ARDS severity does escalation therapy become indicated?

How does rescue therapy differ for moderate vs severe ARDS?