Clinical Research—AdultIncidence of acute respiratory distress syndrome and its relation to age☆
Introduction
Patients with acute respiratory distress syndrome (ARDS) continue to pose a major challenge to intensive care units (ICUs) because of their elevated mortality rate and high resource consumption. The incidence of ARDS is controversial, with historic estimates varying from 1.5 to 75 cases per 100 000 inhabitants per year [1], [2], [3], [4], [5], [6], [7], [8], [9]. In the 1980s and early 1990s, a series of studies using different methodologies all reported a low incidence of ARDS that never exceeded 10 cases per 100 000 inhabitants per year [2], [3], [4], [5].
Since 1994, studies adopting American-European Consensus Conference (AECC) criteria [10] have described higher incidences [6], [7], [8], [9]. It is not clear whether the application of these criteria had any influence on this reported increase. However, a real increase in the incidence of ARDS cannot be ruled out, possibly produced by changes in ICU admission policies. A key policy change over the past 25 years has been the removal of age restrictions for ICU admission. The resulting aging of the ICU patient population may have increased the incidence of ARDS, which is reportedly much higher in elderly patients [11].
Our objective was to determine the incidence of ARDS in Granada province, both overall and by age group.
Section snippets
Methods
A prospective observational study was conducted during 2 study periods (January 8 to April 8 and June 1 to July 31, 2001). The study included all adult hospital units in Granada province: 5 medical-surgical ICUs, 3 surgical ICUs, and 1 neurotrauma ICU, offering a total of 94 ICU beds. The population of Granada province older than 14 years was 633 188 in the 2001 census.
We enrolled all residents of Granada province older than 14 years old, admitted to the ICU during the study period with acute
Results
During the 5-month study period, 1563 patients were admitted to the 9 adult units in the study; 299 (19%) of these patients were ventilated for at least 24 hours, and 252 of these were residents of Granada province, representing an incidence in the province of 97 ventilated cases per 100 000 inhabitants per year. Of the 299 ventilated patients, 76 fulfilled AECC criteria for ARDS during their stay; 61 of these patients were residents of Granada province and constituted the study group. The
Discussion
Our population-based study revealed an overall incidence of ARDS of 23 cases per 100 000 inhabitants per year in our province. The incidence of ARDS markedly increased with age from 4.3 cases per 100 000 in patients younger than 30 years to 74 cases per 100 000 in patients older than 75 years. The mortality rate of the patients with ARDS was 66%, and it was significantly lower for patients with trauma than for medical or surgical patients.
The incidence of ARDS has been extensively documented for
Acknowledgments
The authors thank Richard Davies for his assistance with the English version.
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2021, Critical Care ClinicsCitation Excerpt :Interestingly, ozone exposure (but no other known pollutants) is also associated with increased risk of ARDS.28 Consistently, older age,8 non-white race (likely a surrogate for “social determinants of disease”),29 and some genetic variants30 have been described as host factors associated with risk of developing ARDS. Although age is a risk factor for developing ARDS, it has not consistently been found to be associated with increased mortality.
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2021, Anaesthesia Critical Care and Pain MedicineCitation Excerpt :This low incidence rate was confirmed by other European epidemiological studies performed in the nineties [16–18]. More recent European studies reported higher incidence rates, such as 10.6 ARDS diagnoses per 100,000 person-years in Finland and 25.5 ARDS diagnoses per 100,000 person-years in Spain [19,20]. While the syndrome has been described in the literature since 1967 [21], the first consensus definition, from the American European Consensus Conference, was adopted in 1994 [22].
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This study was supported in part by RED-GIRA (G03/063) Instituto de Salud Carlos III (Madrid, Spain).