本篇研究的重要任務主要是去瞭解急性呼吸窘迫症候群的病人，在歷經高死亡風
險的臨床病程之後，其存活出院後的存活機率有多高，以及有哪一些因子可以作為出 院之後存活率的預測，本研究雖有許多發現已向前邁進一小步，然而仍有一些研究上 的限制，本人認為藉由這篇研究作為借鏡，期未來研究的策略可以多方思考，則未來 的研究必能對於急性呼吸窘迫症候群存活者預後的瞭解更充分且更有證據力。本人對 於研究限制與建議如下：
一、 收案對象只針對北部一家醫學中心，未將其他地區醫院病患纳入研究中，推論 性較不足。也由於台灣在過去並沒有關於急性肺損傷和急性呼吸窘迫症候群發生率的 流行病學研究，本人認為全民健康保險資料系統的應用，乃為一個具潛力的研究策 略，再藉由初步篩檢工作，找尋可能的病人族群，如同其他較為有效的流行病學一樣，
要瞭解急性肺損傷和急性呼吸窘迫症候群的發生率，需要進行前瞻性研究，最好是世 代性研究。
二、 本研究採取回溯性研究設計(Retrospective cohort design)有其限制，因此未來若可 以進行前瞻性、隨機分組臨床試驗，可以減少回溯性研究的偏差(bias)。前瞻性研究可 以追蹤病患的病情發展，了解病患後續的就醫情形、日常生活功能、生活品質與疾病 後遺症狀，但是前瞻性研究是需要收集更長的時間才能有足夠的病人數以供分析，或 是要整合數家醫院一起進行。未來以世代性研究設計(Prospective cohort design)來證實 ARDS患者的存活率與預後因子是必要的。
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三、 本研究無法判斷ARDS預後的死亡原因，然而在死因分類上面是相當困難，因此 患者在發生ARDS之後，未能追蹤其預後狀況與死因，其因ARDS死亡的推論性較不 足。
四、 本研究透過病歷回顧，無法將病人做完整的分類，僅能就基本人口學特性，與 病例所記載致病因作簡單分類，本人認為未來如果是前瞻性研究可以將其危險因子出 現和發病成為ARDS的時間間隔、影像醫學檢查異常的嚴重性、氧合功能破壞的程 度、全身發炎指數的高低、其他器官衰竭的程度等等，都可以加以量化，這樣針對每 一種指標都可以產生不同的程度上的差異，而且可以利用軟體來分析不同的標記中是 否有一些相關性，本人僅在幾個重要結果變項進行分析，基於上述的觀念，可以對 ARDS的表現進行更精細的分類，亦即增加結果變項，並探討不同風險變項與結果變 項之間的關連性。
直到目前為止，這方面的研究應該還是處於起步階段，急性呼吸窘迫症候群的 研究模式目前仍然有相當大的改善空間，未來的研究應該在臨床和基礎的立足點上更 進一步提供更多的研究證據，以造福病患，提高病人的存活率與生活品質。
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