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==Overview==
==Overview==
Acute respiratory distress syndrome is relatively uncommon, occurring in 1.5-13.5 people per 100,000. It can be associated with a number of trigger conditions such as [[sepsis]], [[pulmonary aspiration|aspiration]], and [[pneumonia]].
The incidence of ARDS is estimated to be 1.5 to 75 cases per 100,000 individuals per year worldwide. The reported incidence varies geographically and is higher in the United States than in other countries.


==Epidemiology==
==Epidemiology and Demographics==
* The annual incidence of ARDS is between 1.5 to 13.5 people per 100,000 in the general population
* Its incidence in the [[intensive care unit]] (ICU), [[mechanical ventilation|mechanically ventilated]] population is much higher. Brun-Buisson ''et al.'' (2004) reported a prevalence of acute lung injury (ALI) (see below) of 16.1% percent in ventilated patients admitted for more than 4 hours. More than half these patients may develop ARDS.
* Mortality varies from 30% to 60%. Usually, [[randomized controlled trials]] in the literature show lower death rates, both in control and treatment patients. This is thought to be due to stricter enrollment criteria. Observational studies generally report 50%-60% mortality.


==Demographics==
===Incidence===
Things that may trigger ARDS:
No reliable comparative epidemiological data of ARDS are available due to the evolution of the diagnostic criteria.<ref>Adhikari, Neill K. J., Robert A. Fowler, Satish Bhagwanjee, and Gordon D. Rubenfeld. “Critical Care and the Global Burden of Critical Illness in Adults.” Lancet (London, England) 376, no. 9749 (October 16, 2010): 1339–46. doi:10.1016/S0140-6736(10)60446-1.</ref> The exact incidence of ARDS as defined by the Berlin definition remains unclear.
* [[Mechanical ventilation]]
 
* [[Sepsis]]
Worldwide, the incidence of ARDS ranges from 1.5 to 75 cases per 100,000 person-years.<ref>Valta, P., A. Uusaro, S. Nunes, E. Ruokonen, and J. Takala. “Acute Respiratory Distress Syndrome: Frequency, Clinical Course, and Costs of Care.” Critical Care Medicine 27, no. 11 (November 1999): 2367–74.</ref> Most studies report the incidence rate of approximately 2 to 8 cases per 100,000 person-years.<ref>“Round Table Conference. Acute Lung Injury.” American Journal of Respiratory and Critical Care Medicine 158, no. 2 (August 1998): 675–79. doi:10.1164/ajrccm.158.2.15823.</ref>
* [[Pneumonia]][[Shock (medical)|shock]]
 
* [[Pulmonary aspiration|Aspiration]]
In the United States, the National Heart and Lung Institute (NHLI) suggested an estimated incidence at 150,000 new cases annually, which translates to a population-based figure of 71 cases per 100,000 person-years.<ref>National Heart and Lung Institute. Task Force on Research in Respiratory Diseases, and National Heart and Lung Institute. Lung Program. Respiratory Diseases; Task Force Report on Problems, Research Approaches, Needs. The Lung Program, National Heart and Lung Institute. [Bethesda, Md., U.S. Dept. of Health, Education, and Welfare, National Institutes of Health] for sale by the Supt. of Docs., U.S. Govt. Print. Off., Washington, 1972. http://archive.org/details/respiratorydisea00nati.</ref> Data from a population-based study reported the crude and age-adjusted incidence of 58.7 and 64.0 cases per 100,000 person-years.<ref>Rubenfeld, Gordon D., Ellen Caldwell, Eve Peabody, Jim Weaver, Diane P. Martin, Margaret Neff, Eric J. Stern, and Leonard D. Hudson. “Incidence and Outcomes of Acute Lung Injury.” The New England Journal of Medicine 353, no. 16 (October 20, 2005): 1685–93. doi:10.1056/NEJMoa050333.</ref>
* [[Physical trauma|trauma]] (especially pulmonary contusion)
 
* [[Surgery|Major surgery]]
In the United Kingdom, the incidence of ARDS is 4.5 cases per 100,000 person-years.<ref>Webster, N. R., A. T. Cohen, and J. F. Nunn. “Adult Respiratory Distress Syndrome--How Many Cases in the UK?” Anaesthesia 43, no. 11 (November 1988): 923–26.</ref>
* Massive [[blood transfusion|transfusions]][[smoke inhalation]]
 
* Drug reaction or [[overdose]]
In Europe, the incidence of ARDS ranges from 4.9 to 13.5 cases per 100,000 person-years.<ref>Linko, Rita, Marjatta Okkonen, Ville Pettilä, Juha Perttilä, Ilkka Parviainen, Esko Ruokonen, Jyrki Tenhunen, Tero Ala-Kokko, Tero Varpula, and FINNALI-study group. “Acute Respiratory Failure in Intensive Care Units. FINNALI: A Prospective Cohort Study.” Intensive Care Medicine 35, no. 8 (August 2009): 1352–61. doi:10.1007/s00134-009-1519-z.</ref><ref>Villar, Jesús, Jesús Blanco, José Manuel Añón, Antonio Santos-Bouza, Lluís Blanch, Alfonso Ambrós, Francisco Gandía, et al. “The ALIEN Study: Incidence and Outcome of Acute Respiratory Distress Syndrome in the Era of Lung Protective Ventilation.” Intensive Care Medicine 37, no. 12 (December 2011): 1932–41. doi:10.1007/s00134-011-2380-4.</ref><ref>Sigurdsson, M. I., K. Sigvaldason, T. S. Gunnarsson, A. Moller, and G. H. Sigurdsson. “Acute Respiratory Distress Syndrome: Nationwide Changes in Incidence, Treatment and Mortality over 23 Years.” Acta Anaesthesiologica Scandinavica 57, no. 1 (January 2013): 37–45. doi:10.1111/aas.12001.</ref><ref>Valta, P., A. Uusaro, S. Nunes, E. Ruokonen, and J. Takala. “Acute Respiratory Distress Syndrome: Frequency, Clinical Course, and Costs of Care.” Critical Care Medicine 27, no. 11 (November 1999): 2367–74.</ref><ref>Luhr, O. R., K. Antonsen, M. Karlsson, S. Aardal, A. Thorsteinsson, C. G. Frostell, and J. Bonde. “Incidence and Mortality after Acute Respiratory Failure and Acute Respiratory Distress Syndrome in Sweden, Denmark, and Iceland. The ARF Study Group.” American Journal of Respiratory and Critical Care Medicine 159, no. 6 (June 1999): 1849–61. doi:10.1164/ajrccm.159.6.9808136.</ref>
* [[Fat emboli]
 
* Reperfusion pulmonary edema after [[lung transplantation]] or pulmonary embolectomy
===Mortality===
* Pneumonia and sepsis are the most common triggers, and pneumonia is present in up to 60% of patients. Pneumonia and sepsis may be either causes or complications of ARDS.
According to the NHLI Task Force Report, the mortality rate of ARDS varies from 25% with optimal care to 70% in the absence of treatment.<ref>National Heart and Lung Institute. Task Force on Research in Respiratory Diseases, and National Heart and Lung Institute. Lung Program. Respiratory Diseases; Task Force Report on Problems, Research Approaches, Needs. The Lung Program, National Heart and Lung Institute. [Bethesda, Md., U.S. Dept. of Health, Education, and Welfare, National Institutes of Health] for sale by the Supt. of Docs., U.S. Govt. Print. Off., Washington, 1972. http://archive.org/details/respiratorydisea00nati.</ref> Report from the American-European Consensus Conference quoted a range of mortality from 10% to as high as 90%.<ref>“The American-European Consensus Conference on ARDS. Definitions, Mechanisms, Relevant Outcomes, and Clinical Trial Coordination. (ATS Journals).” http://www.atsjournals.org/doi/abs/10.1164/ajrccm.149.3.7509706.</ref> Data from population-based studies suggest that the mortality rate ranges from 34.0% to 57.9%.<ref>Rubenfeld, Gordon D., Ellen Caldwell, Eve Peabody, Jim Weaver, Diane P. Martin, Margaret Neff, Eric J. Stern, and Leonard D. Hudson. “Incidence and Outcomes of Acute Lung Injury.” The New England Journal of Medicine 353, no. 16 (October 20, 2005): 1685–93. doi:10.1056/NEJMoa050333.</ref><ref>Luhr, O. R., K. Antonsen, M. Karlsson, S. Aardal, A. Thorsteinsson, C. G. Frostell, and J. Bonde. “Incidence and Mortality after Acute Respiratory Failure and Acute Respiratory Distress Syndrome in Sweden, Denmark, and Iceland. The ARF Study Group.” American Journal of Respiratory and Critical Care Medicine 159, no. 6 (June 1999): 1849–61. doi:10.1164/ajrccm.159.6.9808136.</ref><ref>Brun-Buisson, Christian, Cosetta Minelli, Guido Bertolini, Luca Brazzi, Jorge Pimentel, Klaus Lewandowski, Julian Bion, et al. “Epidemiology and Outcome of Acute Lung Injury in European Intensive Care Units. Results from the ALIVE Study.” Intensive Care Medicine 30, no. 1 (January 2004): 51–61. doi:10.1007/s00134-003-2022-6.</ref><ref>Bersten, Andrew D., Cyrus Edibam, Tamara Hunt, John Moran, and Australian and New Zealand Intensive Care Society Clinical Trials Group. “Incidence and Mortality of Acute Lung Injury and the Acute Respiratory Distress Syndrome in Three Australian States.” American Journal of Respiratory and Critical Care Medicine 165, no. 4 (February 15, 2002): 443–48. doi:10.1164/ajrccm.165.4.2101124.</ref>
* Elevated abdominal pressure of any cause is also probably a risk factor for the development of ARDS, particularly during mechanical ventilation.
 
===Age===
The incidence of ARDS increases with age. Data from a population-based study indicated that the groups with the lowest and highest age-specific incidence are 15 through 19 years of age and 75 through 84 years of age, respectively. Mortality also increases with age from a minimum of 24% among those 15 through 19 years old to 60% among those 85 years or older.<ref>Rubenfeld, Gordon D., Ellen Caldwell, Eve Peabody, Jim Weaver, Diane P. Martin, Margaret Neff, Eric J. Stern, and Leonard D. Hudson. “Incidence and Outcomes of Acute Lung Injury.” The New England Journal of Medicine 353, no. 16 (October 20, 2005): 1685–93. doi:10.1056/NEJMoa050333.</ref>
 
===Gender===
Women are slightly more commonly affected with ARDS than men. However, the [[mortality rate]] is slightly higher among men than women.<ref name="pmid12163776">{{cite journal| author=Moss M, Mannino DM| title=Race and gender differences in acute respiratory distress syndrome deaths in the United States: an analysis of multiple-cause mortality data (1979- 1996). | journal=Crit Care Med | year= 2002 | volume= 30 | issue= 8 | pages= 1679-85 | pmid=12163776 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12163776  }} </ref><ref name="pmid21986736">{{cite journal| author=Heffernan DS, Dossett LA, Lightfoot MA, Fremont RD, Ware LB, Sawyer RG et al.| title=Gender and acute respiratory distress syndrome in critically injured adults: a prospective study. | journal=J Trauma | year= 2011 | volume= 71 | issue= 4 | pages= 878-83; discussion 883-5 | pmid=21986736 | doi=10.1097/TA.0b013e31822c0d31 | pmc=3201740 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21986736  }} </ref>
 
===Race===
There is no racial predilection for the development of ARDS. However, African-American race is associated with an increased [[mortality]] among patients with ARDS.<ref name="pmid12163776">{{cite journal| author=Moss M, Mannino DM| title=Race and gender differences in acute respiratory distress syndrome deaths in the United States: an analysis of multiple-cause mortality data (1979- 1996). | journal=Crit Care Med | year= 2002 | volume= 30 | issue= 8 | pages= 1679-85 | pmid=12163776 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12163776  }} </ref>


==References==
==References==
{{Reflist|2}}
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Latest revision as of 14:20, 15 July 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Brian Shaller, M.D. [2]

Overview

The incidence of ARDS is estimated to be 1.5 to 75 cases per 100,000 individuals per year worldwide. The reported incidence varies geographically and is higher in the United States than in other countries.

Epidemiology and Demographics

Incidence

No reliable comparative epidemiological data of ARDS are available due to the evolution of the diagnostic criteria.[1] The exact incidence of ARDS as defined by the Berlin definition remains unclear.

Worldwide, the incidence of ARDS ranges from 1.5 to 75 cases per 100,000 person-years.[2] Most studies report the incidence rate of approximately 2 to 8 cases per 100,000 person-years.[3]

In the United States, the National Heart and Lung Institute (NHLI) suggested an estimated incidence at 150,000 new cases annually, which translates to a population-based figure of 71 cases per 100,000 person-years.[4] Data from a population-based study reported the crude and age-adjusted incidence of 58.7 and 64.0 cases per 100,000 person-years.[5]

In the United Kingdom, the incidence of ARDS is 4.5 cases per 100,000 person-years.[6]

In Europe, the incidence of ARDS ranges from 4.9 to 13.5 cases per 100,000 person-years.[7][8][9][10][11]

Mortality

According to the NHLI Task Force Report, the mortality rate of ARDS varies from 25% with optimal care to 70% in the absence of treatment.[12] Report from the American-European Consensus Conference quoted a range of mortality from 10% to as high as 90%.[13] Data from population-based studies suggest that the mortality rate ranges from 34.0% to 57.9%.[14][15][16][17]

Age

The incidence of ARDS increases with age. Data from a population-based study indicated that the groups with the lowest and highest age-specific incidence are 15 through 19 years of age and 75 through 84 years of age, respectively. Mortality also increases with age from a minimum of 24% among those 15 through 19 years old to 60% among those 85 years or older.[18]

Gender

Women are slightly more commonly affected with ARDS than men. However, the mortality rate is slightly higher among men than women.[19][20]

Race

There is no racial predilection for the development of ARDS. However, African-American race is associated with an increased mortality among patients with ARDS.[19]

References

  1. ↑ Adhikari, Neill K. J., Robert A. Fowler, Satish Bhagwanjee, and Gordon D. Rubenfeld. “Critical Care and the Global Burden of Critical Illness in Adults.” Lancet (London, England) 376, no. 9749 (October 16, 2010): 1339–46. doi:10.1016/S0140-6736(10)60446-1.
  2. ↑ Valta, P., A. Uusaro, S. Nunes, E. Ruokonen, and J. Takala. “Acute Respiratory Distress Syndrome: Frequency, Clinical Course, and Costs of Care.” Critical Care Medicine 27, no. 11 (November 1999): 2367–74.
  3. ↑ “Round Table Conference. Acute Lung Injury.” American Journal of Respiratory and Critical Care Medicine 158, no. 2 (August 1998): 675–79. doi:10.1164/ajrccm.158.2.15823.
  4. ↑ National Heart and Lung Institute. Task Force on Research in Respiratory Diseases, and National Heart and Lung Institute. Lung Program. Respiratory Diseases; Task Force Report on Problems, Research Approaches, Needs. The Lung Program, National Heart and Lung Institute. [Bethesda, Md., U.S. Dept. of Health, Education, and Welfare, National Institutes of Health] for sale by the Supt. of Docs., U.S. Govt. Print. Off., Washington, 1972. http://archive.org/details/respiratorydisea00nati.
  5. ↑ Rubenfeld, Gordon D., Ellen Caldwell, Eve Peabody, Jim Weaver, Diane P. Martin, Margaret Neff, Eric J. Stern, and Leonard D. Hudson. “Incidence and Outcomes of Acute Lung Injury.” The New England Journal of Medicine 353, no. 16 (October 20, 2005): 1685–93. doi:10.1056/NEJMoa050333.
  6. ↑ Webster, N. R., A. T. Cohen, and J. F. Nunn. “Adult Respiratory Distress Syndrome--How Many Cases in the UK?” Anaesthesia 43, no. 11 (November 1988): 923–26.
  7. ↑ Linko, Rita, Marjatta Okkonen, Ville Pettilä, Juha Perttilä, Ilkka Parviainen, Esko Ruokonen, Jyrki Tenhunen, Tero Ala-Kokko, Tero Varpula, and FINNALI-study group. “Acute Respiratory Failure in Intensive Care Units. FINNALI: A Prospective Cohort Study.” Intensive Care Medicine 35, no. 8 (August 2009): 1352–61. doi:10.1007/s00134-009-1519-z.
  8. ↑ Villar, Jesús, Jesús Blanco, José Manuel Añón, Antonio Santos-Bouza, Lluís Blanch, Alfonso Ambrós, Francisco Gandía, et al. “The ALIEN Study: Incidence and Outcome of Acute Respiratory Distress Syndrome in the Era of Lung Protective Ventilation.” Intensive Care Medicine 37, no. 12 (December 2011): 1932–41. doi:10.1007/s00134-011-2380-4.
  9. ↑ Sigurdsson, M. I., K. Sigvaldason, T. S. Gunnarsson, A. Moller, and G. H. Sigurdsson. “Acute Respiratory Distress Syndrome: Nationwide Changes in Incidence, Treatment and Mortality over 23 Years.” Acta Anaesthesiologica Scandinavica 57, no. 1 (January 2013): 37–45. doi:10.1111/aas.12001.
  10. ↑ Valta, P., A. Uusaro, S. Nunes, E. Ruokonen, and J. Takala. “Acute Respiratory Distress Syndrome: Frequency, Clinical Course, and Costs of Care.” Critical Care Medicine 27, no. 11 (November 1999): 2367–74.
  11. ↑ Luhr, O. R., K. Antonsen, M. Karlsson, S. Aardal, A. Thorsteinsson, C. G. Frostell, and J. Bonde. “Incidence and Mortality after Acute Respiratory Failure and Acute Respiratory Distress Syndrome in Sweden, Denmark, and Iceland. The ARF Study Group.” American Journal of Respiratory and Critical Care Medicine 159, no. 6 (June 1999): 1849–61. doi:10.1164/ajrccm.159.6.9808136.
  12. ↑ National Heart and Lung Institute. Task Force on Research in Respiratory Diseases, and National Heart and Lung Institute. Lung Program. Respiratory Diseases; Task Force Report on Problems, Research Approaches, Needs. The Lung Program, National Heart and Lung Institute. [Bethesda, Md., U.S. Dept. of Health, Education, and Welfare, National Institutes of Health] for sale by the Supt. of Docs., U.S. Govt. Print. Off., Washington, 1972. http://archive.org/details/respiratorydisea00nati.
  13. ↑ “The American-European Consensus Conference on ARDS. Definitions, Mechanisms, Relevant Outcomes, and Clinical Trial Coordination. (ATS Journals).” http://www.atsjournals.org/doi/abs/10.1164/ajrccm.149.3.7509706.
  14. ↑ Rubenfeld, Gordon D., Ellen Caldwell, Eve Peabody, Jim Weaver, Diane P. Martin, Margaret Neff, Eric J. Stern, and Leonard D. Hudson. “Incidence and Outcomes of Acute Lung Injury.” The New England Journal of Medicine 353, no. 16 (October 20, 2005): 1685–93. doi:10.1056/NEJMoa050333.
  15. ↑ Luhr, O. R., K. Antonsen, M. Karlsson, S. Aardal, A. Thorsteinsson, C. G. Frostell, and J. Bonde. “Incidence and Mortality after Acute Respiratory Failure and Acute Respiratory Distress Syndrome in Sweden, Denmark, and Iceland. The ARF Study Group.” American Journal of Respiratory and Critical Care Medicine 159, no. 6 (June 1999): 1849–61. doi:10.1164/ajrccm.159.6.9808136.
  16. ↑ Brun-Buisson, Christian, Cosetta Minelli, Guido Bertolini, Luca Brazzi, Jorge Pimentel, Klaus Lewandowski, Julian Bion, et al. “Epidemiology and Outcome of Acute Lung Injury in European Intensive Care Units. Results from the ALIVE Study.” Intensive Care Medicine 30, no. 1 (January 2004): 51–61. doi:10.1007/s00134-003-2022-6.
  17. ↑ Bersten, Andrew D., Cyrus Edibam, Tamara Hunt, John Moran, and Australian and New Zealand Intensive Care Society Clinical Trials Group. “Incidence and Mortality of Acute Lung Injury and the Acute Respiratory Distress Syndrome in Three Australian States.” American Journal of Respiratory and Critical Care Medicine 165, no. 4 (February 15, 2002): 443–48. doi:10.1164/ajrccm.165.4.2101124.
  18. ↑ Rubenfeld, Gordon D., Ellen Caldwell, Eve Peabody, Jim Weaver, Diane P. Martin, Margaret Neff, Eric J. Stern, and Leonard D. Hudson. “Incidence and Outcomes of Acute Lung Injury.” The New England Journal of Medicine 353, no. 16 (October 20, 2005): 1685–93. doi:10.1056/NEJMoa050333.
  19. ↑ 19.0 19.1 Moss M, Mannino DM (2002). "Race and gender differences in acute respiratory distress syndrome deaths in the United States: an analysis of multiple-cause mortality data (1979- 1996)". Crit Care Med. 30 (8): 1679–85. PMID 12163776.
  20. ↑ Heffernan DS, Dossett LA, Lightfoot MA, Fremont RD, Ware LB, Sawyer RG; et al. (2011). "Gender and acute respiratory distress syndrome in critically injured adults: a prospective study". J Trauma. 71 (4): 878–83, discussion 883-5. doi:10.1097/TA.0b013e31822c0d31. PMC 3201740. PMID 21986736.
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