The changing prognosis of ARDS.

It seems likely that the prognosis of ARDS has indeed improved. To what extent is still uncertain, and unfortunately, from what is unknown. As a result, we don't know where to concentrate additional effort and resources. If survival has improved, changes in supportive therapy are the most likely cause. Thus, it is cynical and misdirected to assume that all methods of "supportive" care are equivalent, and that efforts to optimize such care are less worthy than those directed toward potentially specific causes. The situation is analogous to that seen previously in the management of myocardial infarction. Although breakthroughs in thrombolysis and angioplasty have occupied our attention in the past decade, the mortality from myocardial infarction fell dramatically in the decades that preceded these new therapeutic advances. All such improvements are to be hailed and appreciated, and further improvements, both in supportive and specific therapy should be anticipated as likely and welcome.