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Trauma, pancreatitis, and multiple transfusions scored 10 out of 18; the presence of shock or fractures scored 9 out of 18; and fat embolism, disseminated intravascular coagulation, and cardiopulmonary bypass all scored an 8. In reviewing this study it is important to realize that the strength of causation was influenced by the quality of the primary studies. The most common risk factors for ARDS have generally been reported to be sepsis, aspiration, and multiple trauma (46). The risk of developing ARDS increases with the number of risk factors.

These differences in severity of illness likely account, in part, for the respective differences in longterm survival. The relative proportion of patients requiring mechanical ventilation also impacts on the average long-term survival, explaining in part the apparently lower survival in the study by Menzies and colleagues (113). Overall it appears that prior to noninvasive ventilation, the average oneyear survival after an acute exacerbation with associated acute respiratory failure was in the neighborhood of 50%.

Finally, most studies have been conducted in academic centers, and generalizing these findings to community hospitals may misrepresent true practice. Keeping these limitations in mind, we will explore the various etiologies of respiratory failure and see whether there appear to be any trends over time. The most common reason for intubation and mechanical ventilation is elective surgery. In general or nonspecialized ICUs, postoperative surgical patients made up the majority of ventilated patients in North America during the 1970s and 1980s (3,6–9,19–21) (Table 3).

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Cisco - SNMP Management from the Mainframe


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