Validation of diagnostic criteria for ARDS in low resource populations

Acute Respiratory Distress Syndrome (ARDS) is a clinical syndrome of multiple etiologies that leads to widespread alveolar inflammation, hyaline membrane formation and noncompliant lungs. ARDS remains underdiagnosed and undertreated with a high mortality rate in high and low income countries. There are limited treatment options for ARDS, including protective lung ventilation, fluid management, prone positioning and ECMO, which may not be used for a patient if they are not diagnosed correctly with ARDS. ARDS is underdiagnosed in low income countries due to the lack of resources, and the resulting lack of access to invasive tools used in the current gold standard diagnostic criteria for ARDS, the Berlin Criteria. To address this issue, Riviello and colleagues introduced the Kigali criteria, that diagnose ARDS using noninvasive tools which are available in low income nations. Vercesi and colleagues examined the Kigali criteria in ICU patients in the Netherlands and found a strong specificity when using stricter Lung Ultrasound criteria. The purpose of this study is to validate the utilization of the Kigali criteria in the early diagnosis of ARDS, with the use of echocardiography, physical exam findings, strict lung ultrasound criteria, and SpO2/FiO2 in screening patients on arrival to Emergency Departments and repeatedly during admission to 7 hospitals in the Boston area