Most deaths in acute respiratory distress syndrome (ARDS) patients are not directly related to lung damage but to extrapulmonary multisystem organ failure. It would be challenging to prove that specific lung-directed therapies have an effect on overall survival. We examined death in the ICU from individual causes. Overall ICU mortality was 38.8% (95% CI, 35.4–42.3). Causes of acute respiratory distress syndrome modified the risk of death. Twenty-three percent of deaths occurred from refractory hypoxemia due to nonresolving acute respiratory distress syndrome.

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