Timing of the onset of acute respiratory distress syndrome: A population-based study

Giath Shari, Marija Kojicic, Guangxi Li, Rodrigo Cartin-Ceba, Cesar Trillo Alvarez, Rahul Kashyap, Yue Dong, Jaise T. Poulose, Vitaly Herasevich, Javier A.Cabello Garza, Ognjen Gajic

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


BACKGROUND: Many patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) have had recent healthcare interventions prior to developing ALI/ARDS. OBJECTIVE: To determine the timing of ALI/ARDS onset in relation to hospital admission and other healthcare interventions. METHODS: We conducted a population-based observational cohort study with a validated electronic surveillance tool, and identified patients with possible ALI/ARDS among critically ill adults at Mayo Clinic hospitals that provide critical care services for Olmsted County, Minnesota, in 2006. Trained investigators independently reviewed electronic medical records and confirmed the presence and timing of ALI/ARDS based on the American-European consensus definition. RESULTS: Of 124 episodes of ALI in 118 patients, only 5 did not fulfill the ARDS criteria. The syndrome developed a median 30 hours (IQR 10-82 h) after hospital admission in 79 patients (67%). ARDS was present on admission in 39 patients (33%), of whom 14 had recent hospitalization, 6 were transferred from nursing homes, and 3 had recent out-patient contact (1 antibiotic prescription, 1 surgical intervention, and 1 chemotherapy). Only 16 ARDS patients (14%) did not have known recent contact with a healthcare system. Compared to ARDS on admission, hospital-acquired ARDS was more likely to occur in surgery patients (54% vs 15%, P <.001), and had longer adjusted hospital stay (mean difference 8.9 d, 95% CI 0.3-17.4, P =.04). CONCLUSIONS: ARDS in the community most often develops either during hospitalization or in patients who recently had contact with a healthcare system. These findings have important implications for potential preventive strategies.

Original languageEnglish (US)
Pages (from-to)576-582
Number of pages7
JournalRespiratory care
Issue number5
StatePublished - May 2011


  • Acute respiratory distress syndrome
  • Ards
  • Community
  • Critical illness
  • Healthcare

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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