Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome is a common cause of mortality and morbidity, affecting an estimated 150,000 people per year in the United States (Rubenfeld, Doyle, & Matthay, 1995) however, recent evidence suggests the incidence may be higher (Rubenfeld, 2003). Compared to 20 years ago mortality has decreased from 80% to 30% of ARDS participants (Milberg, Davis, Steinberg, & Hudson, 1995; Brower et al., 2000) resulting in approximately 100,000 people who survive ARDS each year in the United States (Bersten, Edibam, Hunt, & Moran, 2002). Acute respiratory distress syndrome occurs in response to a variety of insults including sepsis, trauma, pneumonia, massive transfusion and other medical/surgical conditions. Treatment of ARDS requires aggressive supportive care including positive pressure ventilation (Brower et al., 2000) and increased oxygen concentrations with risks of barotrauma, oxygen toxicity, and nosocomial infection.

Acute respiratory distress syndrome may be a consequence of multiple organ system dysfunction, including the central nervous system (Bell, Coalson, Smith, & Johanson, 1983; Montgomery, Stager, Carrico, & Hudson, 1985). Participants who survive ARDS are at risk for neuropsychological deficits (Hopkins et al., 1999; Rothenhausler, Ehrentraut, Schelling, & Kapfhammer, 2001; Al-Saidi et al., 2003; Hopkins, Weaver, Chan, & Orme, 2004) 6 to 12 months following hospital discharge. Approximately 33% of general medical ICU survivors, some with ARDS, have cognitive impairments (Jackson et al., 2003) 6 months after hospital discharge. In 1999, Hopkins and colleagues found that 45% of ARDS survivors had neurocognitive impairments including impaired memory, attention, concentration, mental processing speed, and global intellectual decline one year post-discharge.

Others have since made similar observations (Marquis et al. 2000; Rothenhausler et al., 2001; Al-Saidi et al., 2003; Jackson et al., 2003). The prevalence of neurocognitive impairments varies from 25% (Rothenhausler et al., 2001) to 78% in participants with more severe ARDS (Hopkins et al., 1999). Neurocognitive impairments are a major determinant in return to work, work productivity, and life satisfaction following ARDS (Rothenhausler et al., 2001).


Al-Saidi, F., McAndrews, M. P., Cheunt, A. M., Tansey, C. M., Matte-Martyn, A., Diaz-Granados, N., et al. (2003). Neuropsychological sequelae in ARDS survivors. American Journal of Respiratory and Critical Care Medicine, 167, A737.

Bell, R. C., Coalson, J. J., Smith, J. D., & Johanson, W. G., Jr. (1983). Multiple organ system failure and infection in adult respiratory distress syndrome. Annals of Internal Medicine, 99, 293–298.

Bersten, A. D., Edibam, C., Hunt, T., & Moran, J. (2002). Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian States. American Journal of Respiratory and Critical Care Medicine, 165, 443–448.

Brower, R. G., Matthay, M. A., Morris, A., Schoenfeld, D., Thompson, B. T., & Wheeler, A. (2000). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. New England Journal of Medicine, 342, 1301–1308.

Hopkins, R. O., Weaver, L. K., Chan, K. J., & Orme, J. F. (2004). Quality of life, emotional, and cognitive function following acute respiratory distress syndrome. Journal of the International Neuropsychological Society, 10, 1005–1017.

Hopkins, R. O., Weaver, L. K., Pope, D., Orme, J. F., Bigler, E. D., & Larson-Lohr, V. (1999). Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 160, 50–56.

Jackson, J. C., Hart, R. P., Gordon, S. M., Shintani, A., Truman, B., May, L., et al. (2003). Six-month neuropsychological outcome of medical intensive care unit participants. Critical Care Medicine, 31, 1226–1234.

Marquis, K., Curtis, J., Caldwell, E., Davidson, T., Davis, J., Sanchez, P., et al. (2000). Neuropsychological sequelae in survivors of ARDS compared with critically ill control participants. American Journal of Respiratory and Critical Care Medicine, 161, A383.

Milberg, J. A., Davis, D. R., Steinberg, K. P., & Hudson, L. D. (1995). Improved survival of participants with acute respiratory distress syndrome (ARDS): 1983-1993. Journal of the American Medical Association, 273, 306–309.

Montgomery, A. B., Stager, M. A., Carrico, C. J., & Hudson, L. D. (1985). Causes of mortality in participants with the adult respiratory distress syndrome. American Review of Respiratory Disease, 132, 485–489.

Rothenhausler, H. B., Ehrentraut, S., Stoll, C., Schelling, G., & Kapfhammer, H. P. (2001). The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: Results of an exploratory study. General Hospital Psychiatry, 23, 90–96.

Rubenfeld, G. D. (2003). Epidemiology of acute lung injury. Critical Care Medicine, 31, S276–S284.

Rubenfeld, G. D., Doyle, R. L., & Matthay, M. A. (1995). Evaluation of definitions of ARDS. American Journal of Respiratory and Critical Care Medicine, 151, 1270–1271.

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