Fig. 1

The Berlin criteria for the definition of ARDS consist of three pillars, each of which is flimsy. Chest X-ray (CXR) infiltrates have a kappa interrater agreement score of 0.296. Arterial PO₂ to fractional inspired oxygen (P/F ratio), an index of patient oxygenation, is physiologically flawed and not fit for purpose. A 7-day interval between the inciting insult and onset of symptoms is whimsical