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

Christian Brun-Buisson, Cosetta Minelli, Guido Bertolini, Luca Brazzi, Jorge Pimentel, Klaus Lewandowski, Julian Bion, Jacques André Romand, Jesús Villar, Adalbjörn Thorsteinsson, Pierre Damas, Apostolos Armaganidis, François Lemaire

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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% (p2O; 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; CI: 1.57-5.28), the severity scores SAPS II (OR: 1.16 per 10% expected mortality; CI: 1.02-1.31) and logistic organ dysfunction (OR: 1.25 per point; CI: 1.13-1.37), a pH less than 7.30 (OR: 1.88; CI: 1.11-3.18) and early air leak (OR: 3.16; CI: 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.

Original languageEnglish
Pages (from-to)51-61
Number of pages11
JournalIntensive Care Medicine
Volume30
Issue number1
DOIs
Publication statusPublished - Jan 2004

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Acute Lung Injury
Intensive Care Units
Epidemiology
Odds Ratio
Adult Respiratory Distress Syndrome
Confidence Intervals
Mortality
Air
Hospital Mortality
varespladib methyl
Cohort Studies
Multivariate Analysis

Keywords

  • Acute lung injury
  • Acute respiratory distress syndrome
  • Barotrauma
  • Epidemiology
  • Mechanical ventilation
  • Positive pressure ventilation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Epidemiology and outcome of acute lung injury in European intensive care units Results from the ALIVE study. / Brun-Buisson, Christian; Minelli, Cosetta; Bertolini, Guido; Brazzi, Luca; Pimentel, Jorge; Lewandowski, Klaus; Bion, Julian; Romand, Jacques André; Villar, Jesús; Thorsteinsson, Adalbjörn; Damas, Pierre; Armaganidis, Apostolos; Lemaire, François.

In: Intensive Care Medicine, Vol. 30, No. 1, 01.2004, p. 51-61.

Research output: Contribution to journalArticle

Brun-Buisson, C, Minelli, C, Bertolini, G, Brazzi, L, Pimentel, J, Lewandowski, K, Bion, J, Romand, JA, Villar, J, Thorsteinsson, A, Damas, P, Armaganidis, A & Lemaire, F 2004, 'Epidemiology and outcome of acute lung injury in European intensive care units Results from the ALIVE study', Intensive Care Medicine, vol. 30, no. 1, pp. 51-61. https://doi.org/10.1007/s00134-003-2022-6
Brun-Buisson, Christian ; Minelli, Cosetta ; Bertolini, Guido ; Brazzi, Luca ; Pimentel, Jorge ; Lewandowski, Klaus ; Bion, Julian ; Romand, Jacques André ; Villar, Jesús ; Thorsteinsson, Adalbjörn ; Damas, Pierre ; Armaganidis, Apostolos ; Lemaire, François. / Epidemiology and outcome of acute lung injury in European intensive care units Results from the ALIVE study. In: Intensive Care Medicine. 2004 ; Vol. 30, No. 1. pp. 51-61.
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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{\%} (p2O; 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; CI: 1.57-5.28), the severity scores SAPS II (OR: 1.16 per 10{\%} expected mortality; CI: 1.02-1.31) and logistic organ dysfunction (OR: 1.25 per point; CI: 1.13-1.37), a pH less than 7.30 (OR: 1.88; CI: 1.11-3.18) and early air leak (OR: 3.16; CI: 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.",
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AU - Pimentel, Jorge

AU - Lewandowski, Klaus

AU - Bion, Julian

AU - Romand, Jacques André

AU - Villar, Jesús

AU - Thorsteinsson, Adalbjörn

AU - Damas, Pierre

AU - Armaganidis, Apostolos

AU - Lemaire, François

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N2 - 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% (p2O; 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; CI: 1.57-5.28), the severity scores SAPS II (OR: 1.16 per 10% expected mortality; CI: 1.02-1.31) and logistic organ dysfunction (OR: 1.25 per point; CI: 1.13-1.37), a pH less than 7.30 (OR: 1.88; CI: 1.11-3.18) and early air leak (OR: 3.16; CI: 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.

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