Acute lung injury (ALI) and ARDS are common and lethal conditions. The spectrum of lung injury represented by ALI/ARDS affects approximately 150,000 people each year in the United States, although the number may be much higher.2 The mortality rate associated with ALI/ARDS depends on the underlying cause, varying from < 20% for traumatically injured patients to > 60% for sepsis-induced ALI/ARDS. Crude estimates of the health-care costs associated with ALI/ARDS may exceed $5 billion per year in the United States alone. Substantial efforts have been devoted to finding effective therapies and improving clinical outcomes, and to date we have had limited, if any, success.
In this issue of CHEST, Stapleton and colleagues provide an expanded report on ALI/ ARDS patients at the University of Washington, From these subjects, they report that the fatality rates of patients with ALI/ARDS have declined over time, with sepsis-related complications being the most common cause of death at nearly 50% and respiratory failure being a relatively uncommon cause of death at < 20%. Importantly, the reductions in patient fatalities are most apparent in patients with trauma-related ALI/ARDS, while patients with sepsis-related lung injury continue to experience the highest fatality rates. The proportion of deaths that occur within the first 3 days after contracting ALI/ARDS compared to those occurring later has not changed, yet it appears that death may be occurring more swiftly for the growing percentage of patients who have life support measures withdrawn.