Intensive Care Medicine

, Volume 30, Issue 1, pp 51–61

Epidemiology and outcome of acute lung injury in European intensive care units

Results from the ALIVE study

Authors

    • Service de Réanimation Médicale, Hôpital Henri Mondor Assistance Publique-Hôpitaux de Paris (AP-HP) & Université Paris XII
  • Cosetta Minelli
    • Centro di Coordinamento GiViTIIstituto di Ricerche Farmacologiche “Mario Negri”
  • Guido Bertolini
    • Centro di Coordinamento GiViTIIstituto di Ricerche Farmacologiche “Mario Negri”
  • Luca Brazzi
    • Istituto di Anestesia e RianimazioneOspedale Maggiore IRCCS
  • Jorge Pimentel
    • Intensive Care UnitUniversity Hospital
  • Klaus Lewandowski
    • Klinik für Anaesthesiologie und operative Intensivmedizin, Charité Campus Virchow-KlinikumHumboldt-Universität zu Berlin
  • Julian Bion
    • University Department of Anaesthesia and Intensive Care MedicineN5 Queen Elizabeth Hospital
  • Jacques-André Romand
    • Surgical intensive care divisionHopitaux Universitaires de Genève
  • Jesús Villar
    • Research InstituteHospital Universitario NS de Candelaria
  • Adalbjörn Thorsteinsson
    • Department of Anesthesia and Intensive Care MedicineLandspitalinn University Hospital Hringbraut
  • Pierre Damas
    • Department of Anesthesia and Intensive CareCentre Hospitalier Universitaire
  • Apostolos Armaganidis
    • Department of Critical CareMedical School of Athens University
  • François Lemaire
    • Service de Réanimation Médicale, Hôpital Henri Mondor Assistance Publique-Hôpitaux de Paris (AP-HP) & Université Paris XII
  • for the ALIVE Study Group
Original

DOI: 10.1007/s00134-003-2022-6

Cite this article as:
Brun-Buisson, C., Minelli, C., Bertolini, G. et al. Intensive Care Med (2004) 30: 51. doi:10.1007/s00134-003-2022-6

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.

Keywords

EpidemiologyAcute lung injuryAcute respiratory distress syndromeMechanical ventilationPositive pressure ventilationBarotrauma

Supplementary material

supp.pdf (38 kb)
Supplementary material (PDF 39 KB)

Copyright information

© Springer-Verlag 2004