Quyen Bach, Mercer University College of Pharmacy
Acute respiratory distress syndrome (ARDS) is an acute inflammatory lung injury associated with increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue. 
It is stated that there is limited information about the epidemiology, recognition, management, and outcomes of patients with ARDS  and that prospective studies have been limited to small numbers of centers and patients. 
|Epidemiology, Patterns of Care, and Mortality for Patients with Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries |
|Design||International, multicenter, prospective cohort; N = 4,499|
|Objective||To determine the intensive care unit (ICU) epidemiology and outcomes from acute respiratory distress syndrome (ADRS), and to understand how clinicians use mechanical ventilation and adjunctive interventions in routine clinical practice|
|Methods||Patients were evaluated daily for acute hypoxemic respiratory failure, defined as the concurrent presence of (1) the ratio of arterial oxygen tension to inspired fraction of oxygen (PaO2/FIO2) of 300 mmHg or less, (2) new pulmonary parenchymal abnormalities on chest x-ray or computed tomography, and (3) ventilator support with continuous positive airway pressure (CPAP), expiratory positive airway pressure (EPAP), or positive end-expiratory pressure (PEEP) of 5 cm H2O or more.|
|Primary Outcome Measure||ICU incidence of ARDS|
|Baseline Characteristics||Parameter||Value||95% CI|
|Mean age, yr||61.5||60.9-62.1|
|Women, no.(%)||1,151 (38)|
|Chronic disease, no. (%)|
|Chronic cardiac failure||314 (10.4)|
|Chronic renal failure||306 (10.1)|
|Active neoplasm||258 (8.5)|
|Hematological disease||142 (4.7)|
|Risk factor for ARDS, no. (%)|
|Extrapulmonary sepsis||484 (16.0)|
|Noncardiogenic shock||226 (7.5)|
|Duration of invasive mechanical ventilation, median, d||8|
|Duration of ICU stay, median, d||10|
|ICU survival, no. (%)||1,994 (66)||64.3-67.7|
|Duration of hospital stay, median, d||17|
|Hospital survival, no. (%)||1,826 (60.4)||58.7-62.2|
|Results||Parameter||Value, no. (%)||95% CI|
|ARDS in first 48h after acute hypoxemic respiratory failure||2,813|
|No longer fulfill ARDS criteria after 24h||486 (17)||15.9-18.7|
|Adverse Events||Common Adverse Events: N/A|
|Serious Adverse Events: N/A|
|Percentage that Discontinued due to Adverse Events: N/A|
|Study Author Conclusions||Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be under-recognized, undertreated, and associated with a high mortality rate.|
Since it was conducted at 459 ICUs in 50 countries on 5 continents, this study showed that ARDS appears to represent an important public health problem globally. One of the study’s limitations was that it was carried out during winter months, which may overestimate ICU incidence figures for ARDS due to season-specific diseases such as influenza. Future studies are warranted to examine the burden of ARDS during different seasons across the globe.
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