title: High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury.
abstract: OBJECTIVE
  Recent data have suggested that ventilatory strategy could influence outcomes from acute lung injury (ALI) and ARDS. We tested the hypothesis that infection/sepsis and use of higher tidal volumes than those applied in the ARDS Network (ARDSnet) study (> 7.4 mL/kg of predicted body weight) would worsen outcome in patients with ALI/ARDS.
  
  
  METHODS
  International cohort, observational study.
  
  
  METHODS
  One hundred ninety-eight European ICUs participating in the Sepsis Occurrence in Acutely Ill Patients study.
  
  
  METHODS
  All 3,147 adult patients admitted to one of the participating ICUs between May 1, 2002, and May 15, 2002.
  
  
  METHODS
  None.
  
  
  RESULTS
  Patients were followed up until death, hospital discharge, or for 60 days. Of the 3,147 patients, 393 patients (12.5%) had ALI/ARDS. ICU and hospital mortality was higher in patients with ALI/ARDS than those without ALI/ARDS (38.9% vs 15.6% and 45.5% vs 21.0%, respectively; p < 0.001). A multivariable logistic regression analysis with ICU outcome as the dependent factor showed that the independent risks for mortality were as follows: presence of cancer, use of tidal volumes higher than those used by the ARDSnet study, degree of multiorgan dysfunction, and higher mean fluid balance. Sepsis, septic shock, and oxygenation at the onset of ALI/ARDS were not independently associated with higher mortality rates.
  
  
  CONCLUSIONS
  In addition to comorbidities and organ dysfunction, high tidal volumes and positive fluid balance are associated with a worse outcome from ALI/ARDS.
authors.affiliation: Department of Intensive Care, Erasme Hospital, University of Brussels, Belgium.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.forename: Johan
authors.initials: J
authors.lastname: Groeneveld
authors.forename: Argyris
authors.initials: A
authors.lastname: Michalopoulos
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
authors.forename: Antonio
authors.initials: A
authors.lastname: Artigas
authors.forename: V Marco
authors.initials: VM
authors.lastname: Ranieri
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D011175:Positive-Pressure Respiration; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012128:Respiratory Distress Syndrome / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D013990:Tidal Volume / Q000502:physiology; D014882:Water-Electrolyte Balance