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