Incidence of acute respiratory distress syndrome (ARDS) in olmsted county

Ourania Preventza, Darrell R. Schroeder, Paul A. Decker, Gregory A. Wilson, Barbara J. Teska, Scott P. Zietlow, Barry A. Harrison, Michael J. Murray

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: ARDS is associated with high morbidity and mortality; despite its importance to intensivists, the true incidence of ARDS has not been determined. The aim of our study was to determine the incidence and outcome (mortality and ventilator-free days) in patients with ARDS in Olmsted County, MN, and the effect of tidal volumes (VT) and steroids on outcome. METHODS: We conducted a retrospective analysis of the medical records of 293 patients who had been prospectively identified by reviewing daily blood gas reports. We tabulated the names of patients with PaO2/FiO2 ratios < 300 mmHg over a 4-year period (1995-1999). Ninety-nine patients, a age 18 who did not object to having their medical records reviewed, were identified. ARDS was defined as 1) PaO2/FiO2 ratios ≤ 200 mmHg on arterial blood gas, 2) bilateral infiltrates on chest radiograph as determined by review of the radiologist's report, 3) pulmonary capillary wedge pressure < 18 mmHg, and for those patients without a pulmonary artery catheter, myocardial dysfunction was ruled out based on echocardiography or clinical history. RESULTS: The female to male ratio was 38/61, the mean age was 63.3 years (range 19-91). The annual incidence of ARDS, adjusted to the 1990 U.S. total population, was 29/100,000 person per year (95% confidence interval: 23-35/100,000). Mortality was significantly associated with increased age (p = 0.016, 2 sample t-test). Medical patients had higher mortality (46%) than surgical patients (26%) (p = 0.048). Ventilator-free days during the first 30 days post-diagnosis were a median of 16 days (X:13.8 ± 12 days [SD]). Initial VT were 9.3 ± 2.1 mL/kg (range 4.6-15.0) with no association with mortality (p = 0.89). Only 29 patients received steroids (NS). CONCLUSION: The lack of an association of mortality with tidal volume is not surprising given the sample size. Our mortality rate in patients with ARDS of 38% is in keeping with observations of a decreasing mortality rate for ARDS. The incidence of ARDS hi a well-defined population is 29/100,000, approximately 4-6 times higher than previously reported (1,2).

Original languageEnglish (US)
Pages (from-to)A126
JournalCritical care medicine
Volume27
Issue number12 SUPPL.
DOIs
StatePublished - 1999

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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