Past and Present ARDS Mortality Rates: A Systematic Review

Area of Science:

• Critical Care Medicine
• Epidemiology
• Respiratory Medicine

Background:

• Acute Respiratory Distress Syndrome (ARDS) is a severe form of respiratory failure impacting critical care patient morbidity and mortality.
• Epidemiological data are vital for assessing therapeutic interventions, study design, and resource allocation in ARDS management.

Purpose of the Study:

• To review and analyze mortality data for Acute Respiratory Distress Syndrome (ARDS) over several decades.
• To identify trends in ARDS mortality based on study methodology, time period, and study design.

Main Methods:

• A systematic literature search of MEDLINE/PubMed was conducted.
• 177 articles were analyzed, categorizing data by methodology (retrospective vs. prospective), mortality type (in-hospital, ICU, 28/30-d, 60-d), and time period (before 1995, 1995-2000, after 2000).
• Linear regression was used to assess the influence of study design and number of centers on mortality rates.

Main Results:

• Overall ARDS mortality rates ranged from 11% to 87%.
• Mortality rates showed a significant linear decrease over time (P < .001) and a negative correlation with the number of centers.
• Prospective studies, including randomized controlled trials and observational studies, generally reported higher mortality rates than retrospective studies, with a notable decrease observed in prospective studies over time.
• Since 2010, reported mortality rates were: in-hospital 45%, ICU 38%, 28/30-d 30%, and 60-d 32%.

Conclusions:

• ARDS mortality has demonstrated a decreasing trend over the past decades, particularly evident in prospective research.
• Study design and the number of participating centers are significant factors influencing reported ARDS mortality rates.
• Recent data indicate substantial in-hospital and ICU mortality for ARDS patients, underscoring the need for continued research and improved therapeutic strategies.