Elsevier

Journal of Critical Care

Volume 20, Issue 3, September 2005, Pages 274-280
Journal of Critical Care

Clinical Research—Adult
Incidence of acute respiratory distress syndrome and its relation to age

https://doi.org/10.1016/j.jcrc.2005.05.008Get rights and content

Abstract

Purpose

The incidence of acute respiratory distress syndrome (ARDS) was previously considered to be relatively low, at less than 10 cases per 100 000 inhabitants per year, but recent reports suggest a higher incidence, especially in elderly patients. The objective was to determine the incidence and mortality of ARDS in our setting, both overall and by age group.

Materials and Methods

We conducted a prospective, observational study of patients older than 14 years, admitted to the intensive care units of all hospitals in a province of southern Spain (Granada) during a 5-month period in 2001. American-European Consensus Conference criteria for ARDS were used. Patients were divided into 5 age groups, and the hospital mortality was recorded.

Results

During the study period, 61 Granada-residing patients developed ARDS criteria. This represents an overall incidence of 23 cases per 100 000 inhabitants per year in the province. The incidence of ARDS in the age groups of 15 to 29, 30 to 44, 45 to 59, 60 to 74, and older than 74 years was 4.6, 13.6, 21.6, 51, and 73.9 cases per 100 000 inhabitants per year, respectively. The overall hospital mortality rate was 66%.

Conclusions

The incidence of ARDS is higher than reported a decade ago and is especially elevated in the elderly. The mortality remains high.

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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    This study was supported in part by RED-GIRA (G03/063) Instituto de Salud Carlos III (Madrid, Spain).

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