Acute respiratory distress syndrome: Resource use and outcomes in 1985 and1995, trends in mortality and comorbidities

Purpose: The purpose of this study was to compare resource consumption and mortality between (ARDS) patients with adult respiratory distress syndrome treated at our center in 1985 (45 patients) and those treated in 1995, Materials and Methods: This was a retrospective observational study, consid ering trauma and nontrauma ARDS separately. We recorded severity index scor es (APACHE III), infectious complications and multiorgan failure, intensive care unit (ICU) resource consumption (TISS 28), length of stay, time on me chanical ventilation, and ICU mortality. Results: We found no variation in overall ARDS mortality and no reduction i n mortality in the ARDS trauma group (43.5% in 1985 vs. 38.5% in 1995, not significant) but a significant increase in mortality among nontrauma septic ARDS patients (68.2% vs. 82.9%, P < .001), largely attributable to the new comorbidities of human immunodeficiency virus (HIV) infection and hematolo gic malignancy. TISS-28 showed an overall reduction over this time period ( 49.7 +/- 6.6 vs. 38.3 +/- 9.7, P < .001), due to fewer monitoring measures, particularly a lower use of pulmonary artery catheter. There were no overa ll changes in length of stay or days on mechanical ventilation between 1985 and 1995, but these variables did increase among the trauma subgroup. Conclusion: In our setting, mortality remained constant from 1985 to 1995 a mong ARDS trauma patients but not among nontrauma ARDS patients because of the new case-mix of the latter population, which now includes HIV and other immunodepressed patients. Copyright (C) 2000 by W.B. Saunders Company.