Understanding the Incidence and Long-term Outcome of ARDS

  • D. C. Angus


Despite the advances made in our understanding of the pathophysiology of ARDS and despite the considerable attention focused on potential new therapies aimed at mitigating the effects of ARDS, we continue to have surprisingly little information regarding the incidence and outcome of ARDS. Previous estimates of the incidence of ARDS in the US vary from 1.5 to 71 cases per 100,000 while mortality ranges vary by almost 10-fold. One explanation for this variation is that ARDS is being measured inconsistently across different studies, for example, by using inconsistent definitions or failing to capture the full duration of the illness process, and thereby underestimating mortality. Alternatively, true variation could exist in both the incidence and mortality between different regions and populations as reflections of differences in underlying risk factors and in patient management.


Systemic Inflammatory Response Syndrome Critical Illness Multisystem Organ Failure Organ Failure Score Resp Crit 
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  1. 1.
    Clermont G, Angus DC (1996) Definitions of patient illness and severity scoring systems. In: Ronco C, Bellomo R (eds) Critical care nephrology, Springer-Verlag (in press)Google Scholar
  2. 2.
    Bernard GR, Artigas A, Brigham KL et al (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Resp Crit Care Med 149(3:Pt 1):818–824PubMedCrossRefGoogle Scholar
  3. 3.
    Rangel-Frausto MS, Pittet D, Costigan M et al (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273(2):117–123PubMedCrossRefGoogle Scholar
  4. 4.
    Salvo I, de Cian W, Musicco M et al (1995) The Italian SEPSIS study: preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shock. Intensive Care Med 21:S244–S249CrossRefGoogle Scholar
  5. 5.
    Dougnac A, Hernandez G, Angus DC et al (1996) Severe SIRS in Chile: Natural history and new organ dysfunction score. Intensive Care Med (in press)Google Scholar
  6. 6.
    Angus DC, Linde-Zwirble WT, Clermont G et al (1996) What’s the incidence and mortality of ARDS in the US? Am J Resp Crit Care Med 153(4):A592Google Scholar
  7. 7.
    Angus DC, Linde-Zwirble WT, Sirio CA et al (1996) The effect of managed care on resource consumption in the ICU. JAMA (in press)Google Scholar
  8. 8.
    Brun-Buisson C (1994) The HA 1 A saga: the scientific and ethical dilemma of innovative and costly therapies. Intensive Care Med 20:314–316PubMedCrossRefGoogle Scholar
  9. 9.
    Morris AH, Wallace CJ, Menlove RL (1994) Randomized controlled trial of pressurecontrolled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Resp Crit Care Med 149:295–305PubMedCrossRefGoogle Scholar
  10. 10.
    Knaus WA, Wagner DP, Draper EA et al (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100(6):1619–1636PubMedCrossRefGoogle Scholar
  11. 11.
    Lemeshow S, Teres D, Klar J et al (1993) Mortality probability models (MPM II) based on an international cohort of intensive care unit patients. JAMA 270(20):2478–2486PubMedCrossRefGoogle Scholar
  12. 12.
    Groeger JS, Guntupalli KK, Strosberg M et al (1993) Descriptive analysis of critical care units in the United States: patient characteristics and intensive care unit utilization. Crit Care Med 21(2):279–291PubMedCrossRefGoogle Scholar
  13. 13.
    Steinwachs DM, Grady M (ed) (1992) Episode of care framework: utility for medical effectiveness research. Rockville, MD. Agency for Health Care Policy and Research (AHCPR). Medical Effectiveness Research Data MethodsGoogle Scholar
  14. 14.
    Salkever DS, German PS, Shapiro S et al (1976) Episodes of illness and access to care in the inner city: a comparison of HMO and non-HMO populations. Health Sery Res 11(3):252–270Google Scholar
  15. 15.
    Angus DC, Linde-Zwirble WT, Sirio CA et al (1995) Understanding post-discharge mortality after prolonged mechanical ventilation. Crit Care Med 1995;23:A55CrossRefGoogle Scholar
  16. 16.
    Knaus WA, Draper EA, Wagner DP et al (1985) Prognosis in acute organ-system failure. Ann Surg 202(6):685–693PubMedCrossRefGoogle Scholar
  17. 17.
    Raffin TA (1989) Intensive care unit survival of patients with systemic illness. Am Rev Respir Dis 140(2):S28-S35CrossRefGoogle Scholar
  18. 18.
    Anonymous (1994) Predicting outcome in ICU patients. 2nd European Consensus Conference in Intensive Care Medicine. Intensive Care Med 20(5):390–397Google Scholar
  19. 19.
    Weinstein MC, Stason WB (1977) Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med 296(13):716–721PubMedCrossRefGoogle Scholar
  20. 20.
    Ridley SA, Wallace PG (1990) Quality of life after intensive care. Anaesthesia 145(10): 808–813CrossRefGoogle Scholar
  21. 21.
    Tarlov AR, Ware JE Jr, Greenfield S et al (1989) The Medical Outcomes Study. An application of methods for monitoring the results of medical care. JAMA 262(7):925–230PubMedCrossRefGoogle Scholar
  22. 22.
    Visser MC, Fletcher AE, Parr G et al (1994) A comparison of three quality of life instruments in subjects with angina pectoris: the Sickness Impact Profile, the Nottingham Health Profile, and the Quality of Well Being Scale. J Clin Epidemiol 47(2):157–163PubMedCrossRefGoogle Scholar
  23. 23.
    Kaplan RM, Atkins CJ, Timms R (1984) Validity of a quality of well-being scale as an outcome measure in chronic obstructive pulmonary disease. J Chronic Dis 37(2):85–95PubMedCrossRefGoogle Scholar
  24. 24.
    Chelluri L, Grenvik A, Silverman M (1995) Intensive care for critically ill elderly: mortality, costs, and quality of life. Review of the literature. Arch Intern Med 155(10):1013–1022PubMedCrossRefGoogle Scholar
  25. 25.
    Slatyer MA, James OF, Moore PG et al (1986) Costs, severity of illness and outcome in intensive care. Anaesth Intensive Care 14(4):381–389PubMedGoogle Scholar
  26. 26.
    Bone RC, Balk RA, Cerra FB et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101(6):1644–1655PubMedCrossRefGoogle Scholar
  27. 27.
    Barriere SL, Lowry SF (1995) An overview of mortality risk prediction in sepsis. Crit Care Med 23(2):376–393PubMedCrossRefGoogle Scholar
  28. 28.
    Marshall JC, Cook DJ, Christou NV et al (1995) Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 23(10):1638–1652PubMedCrossRefGoogle Scholar
  29. 29.
    Angus DC, Dougnac A, Hernandez G et al (1996) Sepsis and SIRS: are we any nearer to consensus? Intensive Care Med (in press)Google Scholar
  30. 30.
    Abizanda R (1990) The facilities. In: Miranda D, William A, Loirate P (eds) Management of the ICU. Guidelines for better use of resources. Dordrecht, The Netherlands: Kluwer Academic Publishers, 55–81Google Scholar

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© Springer-Verlag Italia 1997

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  • D. C. Angus

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