Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients

Objective: To evaluate the prevalence and outcome of the acute respiratory distress syndrome (ARDS) among patients requiring mechanical ventilation. Design: A prospective, multi-institutional, initial cohort study including 28-day follow-up. Settings: Thirty-six French intensive care units (ICUs) from a working grou p of the French Intensive Care Society (SRLF). Patients: All the patients entering the ICUs during a 14-day period were sc reened prospectively. Hypoxemic patients, defined as having a PaO2/FIO2 rat io (P/F) of 300 mmHg or less and receiving mechanical ventilation, were cla ssified into three groups, according to the Consensus Conference on ARDS: g roup 1 refers to ARDS (P/F: 200 mmHg or less and bilateral infiltrates on t he chest X-ray); group 2 to acute lung injury (ALI) without having criteria for ARDS (200 < P/F < 300 mmHg and bilateral infiltrates) and group 3 to p atients with P/F of 300 mmHg or less but having exclusion criteria from the previous groups. Results: Nine hundred seventy-six patients entered the ICUs during the stud y period, 43 % of them being mechanically ventilated and 213 (22 %) meeting the criteria for one of the three groups. Among all the ICU admissions, AR DS, ALI and group 3 patients amounted, respectively, to 6.9% (67), 1.8% (17 ) and 13.3 % (129) of the patients, and represented 31.5%, 8.1% and 60.2 % of the hypoxemic, ventilated patients. The overall mortality rate was 41% a nd was significantly higher in ARDS patients than in the others (60 % vs 31 % p < 0.01). In group 3, 42 patients had P/F less than 200 mmHg associated with unilateral lung injury; mortality was significantly lower (40.5 %) th an in the ARDS group. In the whole group of hypoxemic, ventilated patients, septic shock and severity indices but not oxygenation indices were signifi cantly associated with mortality, while the association with immunosuppress ion revealed only a trend (p = 0.06). Conclusions: In this survey we found that very few patients fulfilled the A LI non-ARDS criteria and that the mortality of the group with ARDS was high .