Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study.
OBJECTIVE
To re-examine the epidemiology of acute lung injury (ALI) in European intensive care units (ICUs).


METHODS
A 2-month inception cohort study in 78 ICUs of 10 European countries.


METHODS
All patients admitted for more than 4 h were screened for ALI and followed up to 2 months.


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 < or =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.
Service de Réanimation Médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP) & Université Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France. christian.brun-buisson@hmn.ap-hop-paris.fr
Christian
C
Brun-Buisson
Cosetta
C
Minelli
Guido
G
Bertolini
Luca
L
Brazzi
Jorge
J
Pimentel
Klaus
K
Lewandowski
Julian
J
Bion
Jacques-André
JA
Romand
Jesús
J
Villar
Adalbjörn
A
Thorsteinsson
Pierre
P
Damas
Apostolos
A
Armaganidis
François
F
Lemaire
D017677:Age Distribution; D000368:Aged; D015984:Causality; D003422:Critical Care / Q000379:methods; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology; D015999:Multivariate Analysis; D011159:Population Surveillance; D011379:Prognosis; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D012720:Severity of Illness Index; D016019:Survival Analysis; D013990:Tidal Volume; D016896:Treatment Outcome