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dc.contributor.authorPisani, Luigi-
dc.contributor.authorAlgera, Anna Geke-
dc.contributor.authorSerpa Neto, Ary-
dc.contributor.authorAzevedo, Luciano-
dc.contributor.authorPham, Tài-
dc.contributor.authorPaulus, Frederique-
dc.contributor.authorde Abreu, Marcelo Gama-
dc.contributor.authorPelosi, Paolo-
dc.contributor.authorDondorp, Arjen M-
dc.contributor.authorBellani, Giacomo-
dc.contributor.authorLaffey, John G-
dc.contributor.authorSchultz, Marcus J-
dc.identifier.citationThe Lancet. Global health 2022; 10(2): e227-e235en
dc.description.abstractGeoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. No funding.en
dc.titleGeoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies.en
dc.typeJournal Articleen
dc.identifier.journaltitleThe Lancet. Global healthen
dc.identifier.affiliationData Analytics Research and Evaluation (DARE) Centreen
dc.identifier.affiliationDepartment of Intensive Care, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands..en
dc.identifier.affiliationMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand..en
dc.identifier.affiliationSection of Operative Research, Doctors with Africa, CUAMM, Padova, Italy..en
dc.identifier.affiliationDepartment of Intensive Care, Miulli Regional General Hospital, Acquaviva delle Fonti, Bari, Italy..en
dc.identifier.affiliationSchool of Public Health and Preventive Medicine, Monash University, Australia..en
dc.identifier.affiliationNew Zealand Intensive Care Research Centre, Melbourne, VIC, Australia..en
dc.identifier.affiliationDepartment of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia..en
dc.identifier.affiliationDepartment of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil..en
dc.identifier.affiliationDepartment of Critical Care Medicine, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil..en
dc.identifier.affiliationKeenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada..en
dc.identifier.affiliationInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada..en
dc.identifier.affiliationPulmonary Engineering Group, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus and Technical University Dresden, Dresden, Germany..en
dc.identifier.affiliationDepartment of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital IRCCS for Oncology, University of Genoa, Genoa, Italy..en
dc.identifier.affiliationNuffield Department of Medicine, University of Oxford, Oxford, UK..en
dc.identifier.affiliationDepartment of Intensive Care, University of Milan Bicocca, Monza, Italy..en
dc.identifier.affiliationDepartment of Medicine and Surgery, University of Milan Bicocca, Monza, Italy..en
dc.identifier.affiliationDepartment of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy..en
dc.identifier.affiliationAnaesthesia and Intensive Care Medicine, School of Medicine, National University of Ireland, and Galway University Hospitals Ireland, Galway, Ireland..en
dc.identifier.affiliationRegenerative Medicine Institute at CÚRAM Centre for Research in Medical Devices, National University of Ireland, and Galway University Hospitals Ireland, Galway, Ireland..en
dc.identifier.affiliationLaboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands..en
dc.identifier.pubmedid34914899- Neto, Ary
item.fulltextNo Fulltext-
item.openairetypeJournal Article-
item.grantfulltextnone- Care- Analytics Research and Evaluation (DARE) Centre-
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