Step 2

Pulmonary 5

44-year-old woman who was previously healthy is admitted to the emergency department in the winter with a 2-day history of fevers, upper respiratory tract symptoms, productive cough and today worsening shortness of breath. Her COVID-19 PCR nasal swab is positive for SARS-CoV-2 and she rapidly deteriorates and requires intubation. Her bedside exam is notable for diffuse rhonchi on lung auscultation, but there is no peripheral edema or notable jugular venous distention, and no S3 or S4 on cardiac exam. Her portable chest x-ray is notable for bilateral diffuse infiltrates. Her initial ventilator settings in the volume assist control (VAC) mode are an FIO2 100%, respiratory rate of 24, tidal volume of 6 mL/kg predicted body weight, and PEEP = 5 cm H2O. After 30 min on these settings, an arterial blood gas (ABG) is performed which has a pH 7.31, Paco2 44 and Pao2 145 mm Hg.

According to the Berlin criteria, what is the classification of this patient's acute hypoxemic respiratory failure?

  • A) Classification cannot be determined until a Swan-Ganz catheter is placed to measure the pulmonary capillary wedge pressure (PCWP)
  • B) Mild ARDS
  • C) Moderate ARDS
  • D) Severe ARDS
  • E) Acute lung injury


Dr. Raj Dasgupta


Dr. Raj Dasgupta