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High Tidal Volume and Positive Fluid Balance Are Associated With Worse Outcome in Acute Lung Injury^*

Yasser Sakr, MB BCh, MSc; Jean-Louis Vincent, MD, PhD, FCCP; Konrad Reinhart, MD, PhD; Johan Groeneveld, MD, PhD, FCCP; Argyris Michalopoulos, MD; Charles L. Sprung, MD; Antonio Artigas, MD; V. Marco Ranieri, MD; on behalf of the Sepsis Occurrence in Acutely Ill Patients Investigators

^* From the Department of Intensive Care (Drs. Sakr and Vincent), Erasme Hospital, Free University of Brussels, Belgium; Department of Anesthesiology and Intensive Care (Dr. Reinhart), Friedrich-Schiller-University Jena, Germany; Department of Intensive Care (Dr. Groeneveld), Vrije Universiteit Medical Centre, Amsterdam, the Netherlands; Department of Intensive Care (Dr. Michalopoulos), Henry Dunant Hospital, Athens, Greece; Department of Anesthesiology and Critical Care Medicine (Dr. Sprung), Hadassah Hebrew University Medical Center, Jerusalem, Israel; Critical Care Center (Dr. Artigas), Sabadell Hospital, University Institute Parc Taulí, Autonomous University of Barcelona, Spain; and Department of Anesthesiology and Intensive Care (Dr. Ranieri), S. Giovanni Battista Hospital, University of Turin, Italy. A complete list of participants is given in the ^Appendix.

Correspondence to: Jean-Louis Vincent, MD, PhD, FCCP, Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, B-1070 Brussels, Belgium; e-mail: jlvincen{at}ulb.ac.be

Study objectives: 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.

Design: International cohort, observational study.

Setting: One hundred ninety-eight European ICUs participating in the Sepsis Occurrence in Acutely Ill Patients study.

Patients or participants: All 3,147 adult patients admitted to one of the participating ICUs between May 1, 2002, and May 15, 2002.

Interventions: None.

Measurements and 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.

Key Words: ARDS • fluid balance • sepsis

This article has been cited by other articles:

				M. Zambon and J.-L. Vincent Mortality Rates for Patients With Acute Lung Injury/ARDS Have Decreased Over Time Chest, May 1, 2008; 133(5): 1120 - 1127. [Abstract] [Full Text] [PDF]

				A. P. Wheeler Recent Developments in the Diagnosis and Management of Severe Sepsis Chest, December 1, 2007; 132(6): 1967 - 1976. [Abstract] [Full Text] [PDF]

				M. A. Matthay and C. S. Calfee Therapeutic Value of a Lung Protective Ventilation Strategy in Acute Lung Injury Chest, November 1, 2005; 128(5): 3089 - 3091. [Full Text] [PDF]

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