Chest
Clinical Investigations in Critical CareHigh Tidal Volume and Positive Fluid Balance Are Associated With Worse Outcome in Acute Lung Injury
Section snippets
Study Design
This prospective, multicenter, observational study included all patients > 15 years old newly admitted to one of 198 ICUs participating in the Sepsis Occurrence in Acutely Ill Patients (SOAP) network in 24 European countries during a 14-day period from May 1, 2002, to May 15, 2002. Clinical sites were recruited by open invitation, and study participation was voluntary with no financial incentive. Institutional review board approval was either waived or expedited in all institutions, and
RESULTS
Of the 3,147 patients included in the SOAP study, 2,025 patients (64.3%) received mechanical ventilation during the ICU stay. Three hundred ninety-three patients (12.5%) had either ALI or ARDS; 85.0% of these patients had ARDS, and 15.0% had ALI. ALI/ARDS was observed on ICU admission in 329 patients (83.5%), while ALI/ARDS developed in the rest 1 to 2 days after ICU admission. Patients with ALI/ARDS had higher ICU (38.9% vs 15.6%, p < 0.001) and hospital (45.5% vs 21.0%, p < 0.001) mortality
DISCUSSION
The major finding of our study was that in addition to comorbidities such as cancer, positive fluid balance, and multiple organ failure, use of a tidal volume higher than the one used in the low tidal volume arm of the ARDSnet study was independently associated with a worse outcome from ALI/ARDS. Infection, sepsis, and septic shock were not associated with a higher mortality. It should be acknowledged that information regarding a number of factors potentially able to influence mortality in the
SOAP INVESTIGATORS
Austria: University Hospital of Vienna (G. Delle Karth); LKH Steyr (V. Draxler); LKH-Deutschlandsberg (G. Filzwieser); Otto Wagner Spital of Vienna (W. Heindl); Krems of Donau (G. Kellner, T. Bauer); Barmherzige Bruede of Linz (K. Lenz); KH Floridsdorf of Vienna (E. Rossmann); University Hospital of Innsbruck (C. Wiedermann); Belgium: CHU of Charleroi (P. Biston); Hôpitaux Iris Sud of Brussels (D. Chochrad); Clinique Europe Site St Michel of Brussels (V. Collin); C.H.U. of Liège (P. Damas);
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This study was endorsed by the European Society of Intensive Care Medicine and supported by an unrestricted grant from Abbott, Baxter, Eli Lilly, GlaxoSmithKline, and NovoNordisk.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).