Chest
Volume 116, Supplement 1, July 1999, Pages 74S-82S
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Epidemiology of Acute Lung Injury and ARDS

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Incidence

The incidences of ARDS and ALI are not clear. A National Institutes of Health panel in 1972 estimated the incidence of ARDS to be 150,000 cases per year in the United States, an incidence of approximately 75/100,000 population per year.2 This number has been widely used since that time without confirmation from epidemiologic studies. Recent prospective studies have found a much lower incidence of ARDS ranging from 1.5 to 8.4 cases per 100,000 population per year.3, 4, 5 The method to perform an

Incidence of ARDS Associated With Clinical Risk Factors

Risk factors or etiologic factors are either conditions that are associated with ARDS or markers that occur in conditions known to be associated with ARDS. These associated conditions can be either direct (primary)—ie, resulting in direct injury to the lung—or indirect (secondary)—ie, a result of extrapulmonary illness or injury that injures the lungs through activation of systemic inflammation, presumably related in part to elevated blood cytokine levels and other biochemical and cellular

Course of ARDS

The onset of identification of the risk factors to the onset of meeting the criteria for ARDS was studied by both the Denver and Seattle studies described above with similar findings,7, 8 and results from the Seattle study are shown in Figure 1. When sepsis syndrome is first identified (all criteria are met), approximately 20% of all patients have already developed ARDS. Only a small percent of trauma patients meet the criteria of ARDS at the onset of trauma, probably since the trauma event is

Mortality

Factors associated with mortality include risk factor and age. Sepsis as a risk for ARDS is generally associated with a considerably higher mortality than most other common risks, including trauma and aspiration of gastric contents.7 Older patients, often studied as patients > 65 years of age, compared with younger patients have an increased mortality rate as determined in several studies.7, 1114, 15 None of these studies considered comorbidities in a multivariant analysis so the effect of age

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