Article (Scientific journals)
Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study
Brun-Buisson, Christian; Minelli, Cosetta; Bertolini, Guido et al.
2004In Intensive Care Medicine, 30 (1), p. 51-61
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Keywords :
Epidemiology; Acute lung injury; Acute respiratory distress syndrome; Mechanical ventilation; Positive pressure ventilation; Barotrauma
Abstract :
[en] Abstract Objectives: To re-examine the epidemiology of acute lung injury (ALI) in European intensive care units (ICUs). Design and setting: A 2-month inception cohort study in 78 ICUs of 10 European countries. Patients: All patients admitted for more than 4 h were screened for ALI and followed up to 2 months. Measurements and main results: Acute lung injury occurred in 463 (7.1%) of 6,522 admissions and 16.1% of all mechanically ventilated patients; 65.4% cases occurred on ICU admission. Among 136 patients initially presenting with “mild ALI” (200< PaO2/FiO2 £300), 74 (55%) evolved to acute respiratory distress syndrome (ARDS) within 3 days. Sixty-two patients (13.4%) remained with mild ALI and 401 had ARDS. The crude ICU and hospital mortalities were 22.6% and 32.7% (p<0.001), and 49.4% and 57.9% (p=0.0005), respectively, for mild ALI and ARDS. ARDS patients initially received a mean tidal volume of 8.3±1.9 ml/kg and a mean PEEP of 7.7±3.6 cmH2O; air leaks occurred in 15.9%. After multivariate analysis, mortality was associated with age (odds ratio (OR) =1.2 per 10 years; 95% confidence interval (CI): 1.05–1.36), immuno-incompetence (OR: 2.88; Cl: 1.57–5.28), the severity scores SAPS II (OR: 1.16 per 10% expected mortality; Cl: 1.02–1.31) and logistic organ dysfunction (OR: 1.25 per point; Cl: 1.13–1.37), a pH less than 7.30 (OR: 1.88; Cl: 1.11–3.18) and early air leak (OR: 3.16; Cl: 1.59–6.28). Conclusions: Acute lung injury was frequent in our sample of European ICUs (7.1%); one third of patients presented with mild ALI, but more than half rapidly evolved to ARDS. While the mortality of ARDS remains high, that of mild ALI is twice as low, confirming the grading of severity between the two forms of the syndrome.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Brun-Buisson, Christian
Minelli, Cosetta
Bertolini, Guido
Brazzi, Luca
Pimentel, Jorge
Lewandowski, Klaus
Bion, Julian
Romand, Jacques-André
Villar, Jesús
Thorsteinsson, Adalbjörn
Damas, Pierre ;  Université de Liège - ULiège > Soins intensifs
Armaganidis, Apostol
Lemaire, François
More authors (3 more) Less
Language :
English
Title :
Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study
Publication date :
2004
Journal title :
Intensive Care Medicine
ISSN :
0342-4642
eISSN :
1432-1238
Publisher :
Springer Verlag, New York, United States - New York
Volume :
30
Issue :
1
Pages :
51-61
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 21 February 2011

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