CLINICAL RISKS FOR DEVELOPMENT OF THE ACUTE RESPIRATORY-DISTRESS SYNDROME

To further understanding of the epidemiology of acute respiratory dist ress syndrome (ARDS), we prospectively identified 695 patients admitte d to our intensive care units from 1983 through 1985 meeting criteria for seven clinical risks, and followed them for development of ARDS an d eventual outcome. ARDS occurred in 179 of the 695 patients (26%). Th e highest incidence of ARDS occurred in patients with sepsis syndrome (75 of 176; 43%) and those with multiple emergency transfusions (great er than or equal to 15 units in 24 h) (46 of 115; 40%). Of patients wi th multiple trauma, 69 of 271 (25%) developed ARDS. If any two clinica l risks for trauma were present, the incidence of ARDS was 23 of 57, o r 40%. During the study period, we identified 48 patients with ARDS wh o did not have one of the defined clinical risks, yielding a sensitivi ty of 79% (179 of 227). Secondary factors associated with increased ri sk for ARDS in clinical risk subgroups include an elevated Acute Physi ologic and Chronic Health Evaluation II (APACHE II) score in patients with sepsis and increased APACHE II and injury Severity Scores (ISS) i n trauma victims. Mortality was threefold higher when ARDS was present (62%) than among patients with clinical risks who did not develop ARD S (19%; p < 0.05). The difference in mortality if ARDS developed was p articularly striking in patients with trauma (56% versus 13%), but les s in those with sepsis (69% versus 49%). The mortality data should be interpreted with caution, since the fatality rate in ARDS patients app ears to have decreased in our institution from the time that these dat a were collected. These findings should be considered in the design of studies aimed at preventing or modifying the development of ARDS.