Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study

2.50
Hdl Handle:
http://hdl.handle.net/2336/3199
Title:
Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study
Authors:
Brun-Buisson, Christian; Minelli, Cosetta; Bertolini, Guido; Brazzi, Luca; Pimentel, Jorge; Lewandowski, Klaus; Bion, Julian; Romand, Jacques-André; Villar, Jesús; Thorsteinsson, Adalbjorn; Damas, Pierre; Armaganidis, Apostolos; Lemaire, François
Citation:
Intensive Care Med 2004, 30(1):51-61
Issue Date:
2004
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 < 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.
Description:
To access publisher full text version of this article. Please click on the hyperlink in Additional Links field
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Full metadata record

DC FieldValue Language
dc.contributor.authorBrun-Buisson, Christian-
dc.contributor.authorMinelli, Cosetta-
dc.contributor.authorBertolini, Guido-
dc.contributor.authorBrazzi, Luca-
dc.contributor.authorPimentel, Jorge-
dc.contributor.authorLewandowski, Klaus-
dc.contributor.authorBion, Julian-
dc.contributor.authorRomand, Jacques-André-
dc.contributor.authorVillar, Jesús-
dc.contributor.authorThorsteinsson, Adalbjorn-
dc.contributor.authorDamas, Pierre-
dc.contributor.authorArmaganidis, Apostolos-
dc.contributor.authorLemaire, François-
dc.date.accessioned2006-06-29T14:07:54Z-
dc.date.available2006-06-29T14:07:54Z-
dc.date.issued2004-
dc.identifier.citationIntensive Care Med 2004, 30(1):51-61en
dc.identifier.issn0342-4642-
dc.identifier.pmid14569423-
dc.identifier.doi10.1007/s00134-003-2022-6-
dc.identifier.urihttp://hdl.handle.net/2336/3199-
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractOBJECTIVES: 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 < 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.en
dc.language.isoenen
dc.publisherSpringeren
dc.relation.urlhttp://www.springerlink.com/content/tbhqkxwtb9t88mjben
dc.subjectAge Distributionen
dc.subjectAgeden
dc.subjectCausalityen
dc.subjectDisease Progressionen
dc.subjectEurope/epidemiologyen
dc.subjectFemaleen
dc.subjectHospital Mortalityen
dc.subjectHumansen
dc.subjectIncidenceen
dc.subjectIntensive Careen
dc.subjectIntensive Care Unitsen
dc.subjectLength of Stayen
dc.subjectLogistic Modelsen
dc.subjectMaleen
dc.subjectMiddle Ageden
dc.subjectMultiple Organ Failureen
dc.subjectMultivariate Analysisen
dc.subjectPopulation Surveillanceen
dc.subjectPrognosisen
dc.subjectProspective Studiesen
dc.subjectResearch Support, Non-U.S. Gov'ten
dc.subjectRespiratory Distress Syndrome, Adulten
dc.subjectSeverity of Illness Indexen
dc.subjectSurvival Analysisen
dc.subjectTidal Volumeen
dc.subjectTreatment Outcomeen
dc.titleEpidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE studyen
dc.typeArticleen
dc.identifier.journalIntensive care medicineen
dc.format.digYES-

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