Acute Respiratory Distress Syndrome in the Intensive Care Unit: Clinical Characteristics, Management, And Prognostic Factors

Introduction: Acute respiratory distress syndrome (ARDS) is a severe form of acute respiratory failure characterized by hypoxemia resulting from diffuse inflammatory injury to the alveolar-capillary barrier. Despite advances in lung-protective mechanical ventilation and adjunctive therapies, mortality remains high. The aim of this study was to describe the clinical, biological, ventilatory, and outcome characteristics of patients with ARDS and to identify factors independently associated with mortality. Methods: We conducted a retrospective, descriptive, and analytical study in the polyvalent intensive care unit of 20 August Hospital, Ibn Rochd University Hospital Center, Casablanca, over a 13-month period from September 2024 to October 2025. Fifty adult patients fulfilling the 2012 Berlin criteria for ARDS were included. Demographic, clinical, biological, blood gas, radiological, ventilatory, and therapeutic data were collected from medical records and the intensive care unit registry. Factors associated with mortality were investigated using univariate and multivariate analyses. Results: The mean age was 53 years, and 70% of patients were male. The most common comorbidities were diabetes mellitus (30%), arterial hypertension (24%), and cardiovascular disease (16%). Invasive mechanical ventilation was required in 48 patients (96%). The mean PaO₂/FiO₂ ratio was 160.8 mmHg. Mild, moderate, and severe ARDS accounted for 26%, 46%, and 28% of cases, respectively. Overall mortality was 50%, with mortality rates of 30.8%, 43.5%, and 78.6% in mild, moderate, and severe ARDS, respectively. In multivariate analysis, factors independently associated with mortality were a SOFA score ≥10, hypotension at admission, a PaO₂/FiO₂ ratio ≤150 mmHg, FiO₂ >0.70, norepinephrine use, pneumonia, PaCO₂ >50 mmHg, and pH <7.30. Conclusion: ARDS was associated with high mortality in this cohort. Initial disease severity, multiorgan dysfunction, severe hypoxemia, and hemodynamic instability were the main prognostic markers. Earlier diagnosis, appropriate implementation of lung-protective ventilation strategies, and improved access to adjunctive therapies remain important priorities.