When ARDS was originally described by Ash baugh et al in 1967 in a series of 12 patients, case fatality approached 60% and remained at approximately that level through the early 1980s. Reported death rates have varied widely, but a study at our institution by Milberg et al in 1993 found that ARDS case fatality had declined to 36%. Similarly, at another institution, Abel et al found that case fatality declined from 66% in a cohort of patients in from 1990 to 1993, to 34% between 1993 and 1997. Explanations for this temporal decrease are not clear. Start treatment right noe and together with Canadian Neighbor Pharmacy.
When causes of death in ARDS patients were analyzed by Montgomery et al in 1982, sepsis syndrome was the major cause of death, while only a relatively small percentage (16%) of deaths were due to insupportable respiratory failure. That study also found that patients who died within the first 72 h after ARDS onset usually died from the presenting injury or illness that preceded ARDS onset. Patients whose deaths occurred > 72 h after ARDS onset most often died from complications (ie, new organ failures) that arose after ARDS began. Prior studies have investigated whether a cause-specific decrease in death of ARDS patients accounts for the overall case fatality decline, but at the present time it remains unknown if cause of death in ARDS has changed concurrently with case fatality. Also unknown is whether a reduction in early or late deaths explains the fall in case fatality, or if the reduced case fatality has varied by ARDS risk factor. Furthermore, several studies have reported that withdrawal of life support in critically ill patients is occurring more frequently now than in the past, but the timing of withdrawal of life support in relation to the onset of ARDS remains unclear. We hypothesized that the reduction in ARDS case fatality over the past 2 decades was related to a change in the relative frequency of sepsis syndrome and multiple organ failure (MOF) as the cause of death.
Gaining insight into the reported decrease in ARDS case fatality and into changes in ARDS epidemiology is important to fully understand the appropriate targets for new therapies. To investigate causes and timing of death, we analyzed these factors in ARDS patients in 1990, 1994, and 1998. Using identical definitions of ARDS and irreversible organ dysfunction leading to death as those used by Montgomery et al, we then compared these data with those from that original study to identify trends over nearly 2 decades at a single institution. While longitudinal mortality rates have been reported, to our knowledge there has not been a study that has longitudinally examined causes of death in ARDS using prospectively identified patients and applying consistent definitions of organ failure over time.