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Related Concept Videos

Assessment of Respiration01:23

Assessment of Respiration

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The respiratory system's basic structures and primary functions lay the foundation for nurses' comprehensive respiratory assessments. This assessment includes subjective and objective data to gauge the patient's respiratory health.
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...
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Respiratory System Abnormal Finding I: Inspection and Percussion01:30

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Respiratory system abnormalities are a significant concern in healthcare due to their potential to indicate underlying severe conditions like Chronic Obstructive Pulmonary Disease (COPD), asthma, and pneumonia. These abnormalities can often be detected through physical examination methods like inspection and percussion.
Inspection Findings
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Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies01:27

Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies

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Assessing and diagnosing Chronic Obstructive Pulmonary Disease (COPD) involves a detailed approach that includes a comprehensive review of medical history, physical examination, and a variety of diagnostic tests. This thorough evaluation is essential to ensure an accurate diagnosis and guide effective management strategies.
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Respiratory Assessment: Purpose and Indications01:19

Respiratory Assessment: Purpose and Indications

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Respiratory assessment is a cornerstone of nursing assessments, crucial for the early detection of patient deterioration. This evaluation transcends routine procedures, representing a critical skill nurses must master to ensure optimal patient care.
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The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
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Physical Assessment of the Respiratory Tract I: Health History01:28

Physical Assessment of the Respiratory Tract I: Health History

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Physical assessment of the respiratory tract is critical to patient care. It allows healthcare professionals to identify and manage various respiratory conditions. The process involves a combination of subjective and objective data collection.
Subjective Data
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Health history and...
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Acute Respiratory Failure-IV01:23

Acute Respiratory Failure-IV

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Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...
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Updated: May 1, 2026

The Application of Point-of-Care Ultrasonography (POCUS) in the Management of Acute Respiratory Distress Syndrome (ARDS) in the Intensive Care Unit
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The Application of Point-of-Care Ultrasonography (POCUS) in the Management of Acute Respiratory Distress Syndrome (ARDS) in the Intensive Care Unit

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Improving retrospective ARDS case-finding using a simple 72-h physiologic persistence rule.

Dominic C Marshall1,2, Brijesh V Patel3, Anthony C Gordon3

  • 1Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK. dominic.marshall12@imperial.ac.uk.

Intensive Care Medicine Experimental
|April 30, 2026
PubMed
Summary
This summary is machine-generated.

A 72-hour persistence rule for hypoxemia improves acute respiratory distress syndrome (ARDS) identification in retrospective studies. However, it remains an enrichment strategy, not a definitive diagnostic label for ARDS.

Keywords:
Acute respiratory distress syndromeCase-findingIdentificationPersistencePhenotyping

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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
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Area of Science:

  • Critical Care Medicine
  • Respiratory Medicine
  • Health Informatics

Background:

  • Retrospective studies often use single-time-point Berlin criteria (PaO2/FiO2 < 300 with PEEP ≥ 5) to identify acute respiratory distress syndrome (ARDS).
  • Transient hypoxemia is common in critically ill patients and may lead to overestimation of ARDS prevalence.
  • Current screening methods may yield cohorts inconsistent with clinical trial populations.

Purpose of the Study:

  • To determine if a 72-hour persistence criterion for hypoxemia improves ARDS case identification accuracy.
  • To evaluate the additional value of radiology keyword searches and ICD codes in ARDS case finding.
  • To assess the impact of varying hypoxemia persistence durations on ARDS prevalence.

Main Methods:

  • Retrospective cohort study using MIMIC-IV and a UK ICU dataset for derivation and validation.
  • Identified patients meeting Berlin criteria for at least 72 hours.
  • Expert adjudication of 2000 patients from MIMIC-IV based on clinical notes, imaging, and echocardiography.
  • Sensitivity analyses performed for 24-h and 48-h persistence criteria.
  • Compared diagnostic performance of radiology keywords and ICD codes against expert adjudication.

Main Results:

  • Of 3940 patients meeting the 72-h persistence threshold, expert adjudication confirmed ARDS in 49.7% (MIMIC-IV) and 56% (UK cohort).
  • ARDS prevalence decreased significantly with shorter persistence: 21% (48h), 8% (24h), and 6% (single measurement).
  • Radiology keywords showed limited sensitivity (49%) and moderate specificity (76%), while ICD codes had higher sensitivity (76%) but low specificity (47%) within the 72-h enriched sample.

Conclusions:

  • Single-time-point Berlin criteria are inadequate for retrospective ARDS identification.
  • A ≥72-hour persistence rule enhances cohort enrichment but does not definitively diagnose ARDS, with residual misclassification.
  • Persistence criteria should be considered a pragmatic enrichment strategy, not a definitive retrospective ARDS label.