Acute Respiratory Distress Syndrome

Fifty years ago, Ashbaugh and colleagues described 12 patients with tachypnea, refractory hypoxemia, and diffuse opacities on chest radiographs after infection or trauma.(1) Prominent hyaline membranes were seen lining the alveolar spaces of the lungs in 6 of the 7 patients who died, findings previously thought to be specific for the respiratory distress syndrome of the newborn. Thus, the term adult (later changed to acute) respiratory distress syndrome (ARDS) was proposed. Since ARDS was last reviewed in the Journal, 17 years ago,(2) substantial progress has been made in the care of affected patients and those at risk for the disorder, with reductions in both incidence and mortality. However, ARDS remains a relatively common and lethal or disabling syndrome. In a recent international study involving 29,144 patients,(3) 10% of all patients admitted to the intensive care unit (ICU) and 23% of mechanically ventilated patients had ARDS. Mortality in the subgroup of patients with severe ARDS was 46%. 3 Patients who survive this disorder are at high risk for cognitive decline, depression, post-traumatic stress disorder, and persistent skeletal-muscle weakness.(4,5)