More than 25 years ago, Ashbaugh and colleagues described a series of patients whose striking but uniform clinical, physiologic, roentgenographic, and pathologic abnormalities distinguished them from other patients who developed respiratory failure. This syndrome has since become known as adult or acute respiratory distress syndrome (ARDS). Despite extensive research and literature devoted to ARDS, overall mortality rates have remained in excess of 40%. The inability to find new therapeutic modalities that decrease mortality rates from this syndrome has been a source of disappointment in this field. Consequently, prevention or early intervention appears to be an important and necessary approach in the management of ARDS. The high mortality rate and lack of success of new interventions have also led to a reevaluation of our basic understanding of ARDS. Thus, revisiting the epidemiology of this syndrome is of paramount importance. By determining the incidence and establishing risk factors for ARDS, invaluable information required to develop preventative strategies or targeted early therapy may surface, offering the hope for improved outcomes in patients afflicted with this syndrome.
In this chapter, we begin by describing possible study designs used in determining epidemiologic features of any disease, including ARDS, in order to better appreciate the strengths and weaknesses of the existing literature. We then describe the major studies estimating the incidence, risk factors, and case-fatality rate of ARDS. We also briefly discuss the long-term outcomes of this illness. In order to provide the reader with the most reliable epidemiologic inferences from the literature, we have primarily based our comments on a systematic search, selection, and appraisal of the published literature.
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