Impact of the Kigali Modifications on ARDS Diagnosis

Background: The Berlin definition of ARDS has recently been expanded to include the Kigali criteria, which allows for the inclusion of more non-intubated patients. However, there is concern that the expanded criteria may be overly inclusive, potentially representing different pathologies. This study evaluates the characteristics of patients with sepsis who meet the Kigali criteria compared with those who meet the original Berlin criteria. Methods: This retrospective cohort study was conducted at a single institution and included subjects aged 18 and older who were admitted for sepsis. Berlin-ARDS was defined by a P_aO2/F_IO2 ratio of ≤300 mm Hg within the first 7 days of admission, the use of intubation or noninvasive ventilation with PEEP of at least 5 cm H₂O, bilateral opacities on chest imaging, and respiratory failure not attributed to heart failure. Kigali-ARDS was defined for subjects who did not meet the Berlin criteria owing to unavailable arterial blood gas values, a P_aO2/F_IO2 ratio >300 mm Hg, or who had a P_aO2/F_IO2 ratio ≤300 mm Hg but were not ventilated with a PEEP of 5 cm H₂O. Results: Of 427 subjects, 73 developed ARDS according to the Berlin criteria, and 94 met the ARDS criteria only by the Kigali definition, whereas 260 did not meet either definition. Smoking was significantly associated with meeting the Kigali criteria (P = .045) but not the Berlin criteria (P = .49). Higher lactate and white blood cell levels were linked to the Berlin criteria (P = .02 and P = .01, respectively) but not to the Kigali criteria. Conclusions: Smoking was a risk factor for meeting the Kigali criteria but not the Berlin criteria, suggesting that the Kigali criteria might include patients with chronic lung conditions rather than true acute lung injury. Additionally, higher lactate and white blood cell levels were associated with Berlin-ARDS, indicating more severe sepsis in these subjects compared with those meeting the Kigali criteria.