What is the incidence of acute respiratory distress syndrome (ARDS) in sepsis/septic shock and what are the potential outcomes?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Acute lung injury (ALI)—mild ARDS, by the Berlin Definition [10] —leading to moderate or severe ARDS is a major complication of sepsis and septic shock. The incidence of ARDS is approximately 18% in patients with septic shock, and mortality approaches 50%. ARDS also leads to prolonged intensive care unit (ICU) stays and an increased incidence of ventilator-associated pneumonia.

ARDS secondary to sepsis demonstrates the manifestations of underlying sepsis and the associated multiple organ dysfunction. Pulmonary manifestations include acute respiratory distress and acute respiratory failure resulting from severe hypoxemia caused by intrapulmonary shunting. Fever and leukocytosis may be present secondary to the lung inflammation.

The severity of ARDS may range from mild lung injury to severe respiratory failure. The onset of ARDS usually is within 12-48 hours of the inciting event. The patients demonstrate severe dyspnea at rest, tachypnea, and hypoxemia; anxiety and agitation are also present.

The frequency of ARDS in sepsis has been reported to range from 18% to 38% (with gram-negative sepsis, 18-25%). Sepsis and multiorgan failure are the most common cause of death in ARDS patients. Approximately 16% of patients with ARDS die of irreversible respiratory failure. Most patients who show improvement achieve maximal recovery by 6 months, with lung function improving to 80-90% of predicted values.

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