The Epidemiology of Alcohol and Acute Respiratory Distress Syndrome

Abstract

Since its first description 50 years ago, no other ICU syndrome has been as extensively studied as ARDS. Nevertheless intensivists' favorite darling has not revealed all its secrets yet and many epidemiological questions remain unsolved. The lack of gold standard tests jeopardizes accurate diagnosis, leading to uncertainties in the actual incidence of this syndrome across different areas with reported ranges as wide as 3.65 to 81 cases per 100,000 persons-year. Likewise evaluation of its evolution over time is difficult due to changes in ARDS definition and under-recognition by clinicians. Despite these limitations, decades of research increased our understanding of pathophysiology and identified important risk factors both for the development of ARDS and for important patients centered outcome such as duration of mechanical ventilation, length of stay in the ICU or in the hospital and mortality. In this critical care perspective we discuss the historical context of ARDS description and consecutive definitions. We highlight the epidemiologic challenges of studying ARDS (as well as other ICU syndromes) and propose solutions to address them. We update the current knowledge ARDS trends in incidence and mortality, risk factors and recently described endotypes.