UMEM Educational Pearls

Is It Really ARDS?

  • Recent literature suggests that the incidence of ARDS in intubated ED patients may be as high as 10%.
  • The Berlin Definition of ARDS includes the acute onset of bliateral opacities (CXR or chest CT) that is not fully explained by pulmonary edema or fluid overload.
  • Emergency physicians and Intensivists are well versed in lung-protective ventilator settings for patients with ARDS.
  • However, several diseases can appear simliar to ARDS and may require different ventilator strategies and treatments.
  • In the absence of clinical risk factors for ARDS (e.g., sepsis, trauma), consider the following in your differential:
    • Idiopathic pulmonary fibrosis
    • Interstitial pneumonitis
    • Granulomatosis with polyangitis (Wegener's)
    • Diffuse alveolar hemorrhage
    • Goodpasture's syndrome


Guerin C, et al. The ten diseases that look like ARDS. Intensive Care Med 2015; 41:1099-1102.