Conclusions
This population-based study suggests that potentially preventable hospital exposures significantly contribute to development of ARDS in at-risk patients. Disciplined attention to healthcare delivery factors and the avoidance of "second hits" is advised to limit the development of ARDS and to improve safety and outcome for critically ill patients. The effectiveness of this approach needs to be prospectively evaluated. Such an approach would present very little risk and, given the lack of treatment options after ARDS has developed, critically ill patients receiving this standardized care would have much to gain.