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

Results from the ALIVE study

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An Erratum to this article was published on 06 February 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 ≤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.

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Acknowledgements

This study was supported by the Working Group on Acute Respiratory Failure of the European Society of Intensive Care Medicine and by an unrestricted grant from Marion Merell Dow. The authors thank the many ICU physicians across Europe who participated and devoted their time to the ALIVE study (See ‘Appendix’ in the ESM), and Prof. Laurent Brochard for his helpful suggestions.

Author information

Authors and Affiliations

  1. 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 Cedex, France

    Christian Brun-Buisson & François Lemaire

  2. Centro di Coordinamento GiViTI, Istituto di Ricerche Farmacologiche “Mario Negri”, Ranica (Bergamo), Italy

    Cosetta Minelli & Guido Bertolini

  3. Istituto di Anestesia e Rianimazione, Ospedale Maggiore IRCCS, Milan, Italy

    Luca Brazzi

  4. Intensive Care Unit, University Hospital, Coimbra, Portugal

    Jorge Pimentel

  5. Klinik für Anaesthesiologie und operative Intensivmedizin, Charité Campus Virchow-Klinikum, Humboldt-Universität zu Berlin, Berlin, Germany

    Klaus Lewandowski

  6. University Department of Anaesthesia and Intensive Care Medicine, N5 Queen Elizabeth Hospital, Birmingham, UK

    Julian Bion

  7. Surgical intensive care division, Hopitaux Universitaires de Genève, Geneva, Switzerland

    Jacques-André Romand

  8. Research Institute, Hospital Universitario NS de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain

    Jesús Villar

  9. Department of Anesthesia and Intensive Care Medicine, Landspitalinn University Hospital Hringbraut, Reykjavik, Iceland

    Adalbjörn Thorsteinsson

  10. Department of Anesthesia and Intensive Care, Centre Hospitalier Universitaire, Liège, Belgium

    Pierre Damas

  11. Department of Critical Care, Medical School of Athens University, Athens, Greece

    Apostolos Armaganidis

Authors
  1. Christian Brun-Buisson
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  2. Cosetta Minelli
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  3. Guido Bertolini
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  4. Luca Brazzi
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  5. Jorge Pimentel
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  6. Klaus Lewandowski
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  7. Julian Bion
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  8. Jacques-André Romand
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  9. Jesús Villar
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  10. Adalbjörn Thorsteinsson
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  11. Pierre Damas
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  12. Apostolos Armaganidis
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  13. François Lemaire
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for the ALIVE Study Group

Corresponding author

Correspondence to Christian Brun-Buisson.

Additional information

An erratum to this article is available at https://doi.org/10.1007/s00134-003-2136-x.

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Brun-Buisson, C., Minelli, C., Bertolini, G. et al. Epidemiology and outcome of acute lung injury in European intensive care units. Intensive Care Med 30, 51–61 (2004). https://doi.org/10.1007/s00134-003-2022-6

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  • DOI: https://doi.org/10.1007/s00134-003-2022-6

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