The impact of aging on outcomes in acute respiratory distress syndrome: a multicenter cohort study

Advanced age significantly influences outcomes in acute respiratory distress syndrome, with implications for intensive care unit-free days, ventilator-free days, and mortality. Understanding these relationships is essential for optimizing care in elderly populations. This retrospective multicenter cohort study included 1992 patients with acute respiratory distress syndrome from the Acute Respiratory Distress Syndrome Network trials, specifically the ALTA (Albuterol for the Treatment of Acute Lung Injury), EDEN (Early vs. Delayed Enteral Nutrition), Omega (Omega-3 Fatty Acid, Gamma-Linolenic Acid, and Anti-Oxidant Supplementation), and SAILS (Statins for Acutely Injured Lungs from Sepsis) studies, categorized into four age groups: < 40 years ( n = 450, 22.6%), 40–60 years ( n = 915, 45.9%), 60–80 years ( n = 536, 26.9%), and > 80 years ( n = 91, 4.6%). Key demographic characteristics, including gender, race, and ethnicity, were analyzed. Regression models adjusted for driving pressure and PaO₂/FiO₂ ratio examined associations between age and intensive care unit-free days, ventilator-free days, and mortality at 60 and 90 days. The results showed that older age was correlated with significantly fewer intensive care unit-free days and ventilator-free days and higher mortality. Patients > 80 years experienced 8.47 fewer intensive care unit-free days (95% CI: –11.24 to –5.69) and 9.26 fewer ventilator-free days (95% CI: –12.22 to –6.31) compared to those < 40 years. Mortality increased with age; 60-day mortality odds ratios were 1.44 (95% CI: 1.02–1.88) for 60–80 years and 2.32 (95% CI: 1.66–3.00) for > 80 years. Results persisted at 90 days. Subgroup analysis revealed demographic disparities: non-Hispanic White patients comprised 77.3%, Black patients 15.4%, and Hispanic ethnicity 11.6%. Men accounted for 50.9% of the cohort. The findings suggest that aging significantly worsens acute respiratory distress syndrome outcomes, with reductions in intensive care unit-free days, ventilator-free days, and survival. Older patients warrant targeted management strategies, emphasizing ventilatory optimization, particularly driving pressure and oxygenation indices, to improve outcomes. These findings underscore the need for personalized approaches to acute respiratory distress syndrome management in elderly populations.