Epidemiology of acute lung injury and acute respiratory distress syndrome in The Netherlands: A survey

Wind, Jan; Versteegt, Jens; Twisk, Jos; van der Werf, Tjip S.; Bindels, Alexander J.G.H.; Spijkstra, Jan-Jaap; Girbes, Armand R.J.; Groeneveld, A.B. Johan

doi:10.1016/j.rmed.2007.05.021

« Previous Next »Respiratory Medicine
Volume 101, Issue 10 , Pages 2091-2098, October 2007

Epidemiology of acute lung injury and acute respiratory distress syndrome in The Netherlands: A survey

Jan Wind
- Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
Jens Versteegt
- Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
Jos Twisk
- Department of Intensive Care, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
Tjip S. van der Werf
- Department of Intensive Care, Catherina Ziekenhuis, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
Alexander J.G.H. Bindels
- Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
Jan-Jaap Spijkstra
- Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
Armand R.J. Girbes
- Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
A.B. Johan Groeneveld
- Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Corresponding author. Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Tel.: +31204444170; fax: +31204442392.

Received 14 March 2007; accepted 25 May 2007. published online 09 July 2007.

Summary

Background

The characteristics, incidence and risk factors for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) may depend on definitions and geography.

Methods

A prospective, 3-day point-prevalence study was performed by a survey of all intensive care units (ICU) in the Netherlands (n=96). Thirty-six ICU's responded (37%), reporting on 266 patients, of whom 151 were mechanically ventilated. The questionnaire included criteria and potential risk factors for ALI/ARDS, according to the North American–European Consensus Conference (NAECC) or the lung injury score (LIS⩾2.5).

Results

Agreement between definitions was fair (κ 0.31–0.42, P=0.001). ALI/ARDS was characterized, regardless of definition, by radiographic densities, low oxygenation ratios, high inspiratory O₂ and airway pressure requirements. Depending on definitions, ALI and ARDS accounted for about 12–33% and 7–9% of ICU admissions per year, respectively, constituting 21–58% (ALI) and 13–16% (ARDS) of all mechanically ventilated patients. The annual incidences of ALI and ARDS are 29.3 (95%CI 18.4–40.1) and 24.0 (95%CI 14.2–33.8) by NAECC, respectively, and are, respectively, 83.6 (95%CI 65.3–101.9) and 20.9 (95%CI 11.7–30.1) by LIS per 100,000. Risk factors for ALI/ARDS were aspiration, pneumonia, sepsis and chronic alcohol abuse (the latter only by NAECC).

Conclusion

The effect of definitions of ALI/ARDS on mechanical ventilation in the Netherlands is small. Nevertheless, the incidence of ALI/ARDS may be higher than in other European countries but lower than in the USA, and the incidence of ALI by LIS may overestimate compared to that by NAECC. Aspiration, pneumonia, sepsis and chronic alcohol abuse are major risk factors, largely independent of definitions.

KEYWORDS: Defining ALI/ARDS, ICU planning, ALI/ARDS incidence, Risk factors, Aspiration pneumonia, Geographical differences