What question did this study set out to answer?

To assess how often palliative care is received by patients with ARDS and identify associated factors.

May 20, 2026

C55-18 Who Gets Palliative Care in ARDS? Insights From a Nationwide Inpatient Sample

Q: What does this research mean for the field?

Acute respiratory distress syndrome (ARDS) is associated with greater inpatient palliative care utilization, with older age, higher comorbidity, prolonged ventilation, and teaching-hospital care independently predicting its receipt among ARDS patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Points

To assess how often palliative care is received by patients with ARDS and identify associated factors.
Cross-sectional study using the National Inpatient Sample (2018-2021)
Inclusion of adults ≥18 years with ARDS identified by ICD-10-CM J80
Survey-weighted logistic regression to analyze associations between ARDS and palliative care.
Among 462,036 ARDS hospitalizations, palliative care utilization was associated with increased in-hospital mortality (OR 5.03, 95% CI 4.77-5.29)
Palliative care showed modest odds of receipt (OR 1.06, 95% CI 1.00-1.12)
Factors such as older age and prolonged ventilation duration were linked to higher odds of receiving palliative care.

Abstract

Abstract Rationale Palliative care (PC) supports goal-concordant treatment in critical illness, yet utilization patterns for patients with acute respiratory distress syndrome (ARDS) remain poorly described. Objectives To quantify the association between ARDS and receipt of inpatient PC and to identify factors independently associated with PC among ARDS hospitalizations. s. Methods We conducted a cross-sectional study of the National Inpatient Sample (NIS) 2018-2021. Adults ≥18 years were included; elective admissions and chronic respiratory failure were excluded. ARDS was identified by ICD-10-CM J80; inpatient PC encounters by Z51. 5; invasive mechanical ventilation (MV) duration and ECMO by procedure codes. Survey design was incorporated with DISCWT (weights), NISSTRATUM (strata), and HOSPNIS (clusters). The primary outcome was receipt of PC. Secondary outcomes included in-hospital mortality, length of stay (LOS), and total charges. We used survey-weighted logistic regression to (1) estimate the association between ARDS and PC among all adult hospitalizations and (2) identify factors associated with PC within ARDS hospitalizations, adjusting for age, sex, race/ethnicity, Elixhauser comorbidity score, and hospital characteristics (region, teaching status, bed size). Analyses were performed in IBM SPSS Statistics v31. Results Among 102, 000, 458 weighted hospitalizations, 462, 036 had ARDS (0. 5%) ; mean age was 67. 7 years, and mean stay was 6. 7 days. In complex-samples logistic regression, mortality showed the strongest association (dead vs alive OR 5. 03, 95% CI 4. 77-5. 29). Palliative care showed a modest increase (yes vs no OR 1. 06, 95% CI 1. 00-1. 12). Males had slightly higher odds (OR 1. 07, 95% CI 1. 04-1. 10). Each year of age lowered odds (OR 0. 985, 95% CI 0. 984-0. 986) ; each hospital day raised odds (OR 1. 011, 95% CI 1. 008-1. 014). Relative to ventilation longer than 96 hours, odds were lower with 24-96 hours (OR 0. 28, 95% CI 0. 27-0. 29) and under 24 hours (OR 0. 44, 95% CI 0. 41-0. 48). By race (vs Other), Native American patients had higher odds (OR 1. 68, 95% CI 1. 35-2. 10), whereas Caucasian and Black patients had lower odds (OR 0. 73, 95% CI 0. 66-0. 81; OR 0. 76, 95% CI 0. 68-0. 86) ; Hispanic and Asian were near unity. Conclusion In a nationally representative cohort, ARDS was associated with greater inpatient palliative care utilization. Within ARDS, older age, higher comorbidity, prolonged ventilation, and teaching-hospital care independently predicted PC receipt. These findings support earlier and standardized PC integration for high-risk ARDS phenotypes. This abstract is funded by: None

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Cite This Study

Martinez-Nachon et al. (Fri,) studied this question.

synapsesocial.com/papers/6a0d50dcf03e14405aa9d075 https://doi.org/https://doi.org/10.1093/ajrccm/aamag162.197

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