Epidemiological trends of mechanically ventilated acute respiratory distress syndrome in the twenty-first century: a nationwide, population-based retrospective study.

Summary

In 93,192 MV-ARDS hospitalizations across Spain (2000–2022), incidence stabilized after peaking in 2021, mortality declined overall, and costs per patient increased and stabilized around €30–40k. During COVID-19, hospital stays lengthened while mortality decreased, with more obesity/diabetes and fungal/viral etiologies.

Key Findings

• Analyzed 93,192 MV-ARDS admissions; incidence ranged 2.96–20.14 per 100,000 person-years, peaking in 2021.
• Hospital mortality ranged 38.0–55.0% with a declining trend over time.
• Cost per patient increased nearly fourfold, stabilizing around €30–40k after a 2011 peak (€42,812).
• During COVID-19, length of stay increased while mortality decreased; higher prevalence of obesity/diabetes and fungal/viral etiologies.

Clinical Implications

Benchmarking MV-ARDS incidence, mortality, and costs supports ICU capacity planning, ECMO/ventilation resource allocation, and prioritization of preventive strategies in high-risk populations.

Limitations

• Retrospective administrative coding may misclassify ARDS severity and etiology.
• Lack of granular clinical variables limits causal inference and phenotype-specific insights.

Future Directions

Link administrative data with clinical registries for phenotype-level analyses; validate trends in other countries; assess drivers of cost and outcomes.