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John A. Milberg, MPH; Donna R. Davis, RN; Kenneth P. Steinberg, MD; Leonard D. Hudson, MD

JAMA. 1995;273(4):306-309.

Abstract
Objective.
—To analyze temporal trends in acute respiratory distress syndrome (ARDS) fatality rates since 1983 at one institution.

Design.
—Cohort.

Setting.
—Intensive care units of a large county hospital.

Patients.
—Consecutive adult patients (18 years of age) meeting ARDS criteria were identified through daily surveillance of intensive care units (N=918 from 1983 through 1993). The major causes were sepsis syndrome in 37% and major trauma in 25%; 37% had other risks. Sixty-five percent were male. The median age was 45 years (range, 18 to 92 years); 70% were younger than 60 years.

Main Outcome Measure.
—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 crude rates were largely unchanged after adjustment for age, ARDS risk, and gender distribution. While patients both younger than 60 years and 60 years or older experienced declines in fatality rate, the larger decrease occurred in the younger cohort. In sepsis patients, ARDS fatality rates declined steadily, from 67% in 1990 to 40% in 1993 (95% confidence interval, 23% to 57%). The decline in sepsis-related ARDS fatality 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 consistent as in the sepsis population.

Conclusions.
—In this large series, we observed a significant decrease in fatality rates occurring largely in 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 experimental 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 associated with this syndrome.

(JAMA. 1995;273:306-309)

Author Affiliations
From the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center/University of Washington, Seattle.

Footnotes
Reprint requests to Division of Pulmonary and Critical Care Medicine, ZA-62, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104 (Mr Milberg).

Concepts in Emergency and Critical Care section editor: Roger C. Bone, MD, Consulting Editor, JAMA.

Advisory Panel: Bart Chernow, MD, Baltimore, Md; David Dantzker, MD, New Hyde Park, NY; Jerrold Leiken, MD, Chicago, Ill; Joseph E. Parrillo, MD, Chicago, Ill; William J. Sibbald, MD, London, Ontario; and Jean-Louis Vincent, MD, PhD, Brussels, Belgium.

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