A 12-month clinical survey of incidence and outcome of acute respiratory distress syndrome in Shanghai intensive care units

Objective: To investigate incidence, causes, and outcome of acute respiratory distress syndrome (ARDS) in adult patients admitted to intensive care units (ICU) in Shanghai. Design: A prospective 12-month survey during 2001-2002 of the predispositions, clinical management strategies, complications, and 90-day survival rates of patients with ARDS. Patients and setting: Fifteen ICU in 12 university hospitals in Shanghai. All ICU admissions greater than or equal to15 years of age in the 12-month period were assessed. Patients fulfilling diagnostic criteria of ARDS, as defined by the American-European Consensus Conference, and having a continuous treatment period greater than or equal to24 h, were recruited. Measurements and results: Of 5320 adult patients admitted to ICUs, there were 108 (2%) with ARDS. At inclusion, ARDS patients had a mean PaO2/FiO(2) value of 111.3+/-40.3 mmHa and a mean acute physiology and chronic health evaluation score (APACHE II) of 17.3+/-8.0; 33 patients had a lung injury score >2.5. Forty-one and 67 patients had ARDS associated with diseases of pulmonary and extrapulmonary origin, respectively. The most common predisposing factors for ARDS were pneumonia (34.3%) and nonpulmonary sepsis (30.6%). The overall ICU mortality was 10.3%. In-hospital and 90-day mortalities of ARDS patients were 68.5 and 70.4%, respectively, and accounted for 13.5% of the overall ICU mortality. For ARDS patients, multiple organ dysfunction syndrome was a major risk factor associated with death (59.5%). Conclusion: The high morbidity and mortality of ARDS in the ICUs in Shanghai require reassessment of respiratory and intensive care management and implementation of effective therapeutic interventions.