IMPROVED SURVIVAL OF PATIENTS WITH ACUTE RESPIRATORY-DISTRESS-SYNDROME (ARDS) - 1983-1993

Objective.-To analyze temporal trends in acute respiratory distress sy ndrome (ARDS) fatality rates since 1983 at one institution. Design.-Co hort. Setting.-Intensive care units of a large county hospital. Patien ts.-Consecutive adult patients (greater than or equal to 18 years of a ge) meeting ARDS criteria were identified through daily surveillance o f intensive care units (N=918 from 1983 through 1993). The major cause s were sepsis syndrome in 37% and major trauma in 25%; 37% had other r isks. Sixty-five percent were male. The median age was 45 years (range , 18 to 92 years); 70% were younger than 60 years. Main Outcome Measur e.-Hospital mortality. Results.-Overall fatality rates showed no trend from 1983 to 1987, declined slightly in 1988 and 1989, and decreased to a low of 36% in 1993 (95% confidence interval, 25% to 46%). The cru de rates were largely unchanged after adjustment for age, ARDS risk, a nd gender distribution. While patients both younger than 60 years and 60 years or older experienced declines in fatality rate, the larger de crease occurred in the younger cohort. In sepsis patients, ARDS fatali ty rates declined steadily, from 67% in 1990 to 40% in 1993 (95% confi dence interval, 23% to 57%). The decline in sepsis-related ARDS fatali ty was confined largely to patients less than 60 years of age. Trauma patients and all other patients also experienced declines in fatality rates after 1987, although these trends were not as strong and consist ent as in the sepsis population. Conclusions.-In this large series, we observed a significant decrease in fatality rates occurring largely i n patients younger than 60 years and in those with sepsis syndrome as their risk for ARDS. We are unable to determine the extent to which ex perimental therapies or other changes in treatment have contributed to the observed decline in the ARDS fatality rate, institution-specific rates and temporal trends in ARDS fatality rates should be considered in clinical trials designed to prevent ARDS and the high mortality ass ociated with this syndrome.