Others diseases, such as pulmonary embolism and acute myocardial infarction, were significantly associated with ARF. The underdiagnosis of pulmonary embolism has been a significant problem in critical care units until recently. 22 Based on the pulmonary histopathological analysis, DAD was the most common pattern observed (40.7% of cases), which is consistent with our previous study. 22 No similar results have been previously found in other studies of ARF patients. Parambil et al 20 described a 90% prevalence of DAD in patients with acute respiratory distress syndrome who underwent surgical lung biopsies. 20, 27 However, these findings are consistent with the higher prevalence and the significant association with BBP of sepsis and/or septic shock, HIV/AIDS and other infectious and inflammatory diseases. Other contributing factors include impeded mechanical ventilation, which can accelerate the development of these histopathologies. 21, 22 Unexpectedly, DAD was also associated with conditions such as liver cirrhosis, acute myocardial infarction, pulmonary embolism, dilated cardiomyopathy and chronic obstructive pulmonary disease. We did not find that this association has been reported elsewhere in the literature, and it probably indicates that a common inflammatory response is present in these distinct pathologies.