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Title: Geoeconomic 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.
Austin Authors: Pisani, Luigi;Algera, Anna Geke;Serpa Neto, Ary ;Azevedo, Luciano;Pham, Tài;Paulus, Frederique;de Abreu, Marcelo Gama;Pelosi, Paolo;Dondorp, Arjen M;Bellani, Giacomo;Laffey, John G;Schultz, Marcus J
Affiliation: Data Analytics Research and Evaluation (DARE) Centre
Department of Intensive Care, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands..
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand..
Section of Operative Research, Doctors with Africa, CUAMM, Padova, Italy..
Department of Intensive Care, Miulli Regional General Hospital, Acquaviva delle Fonti, Bari, Italy..
School of Public Health and Preventive Medicine, Monash University, Australia..
New Zealand Intensive Care Research Centre, Melbourne, VIC, Australia..
Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia..
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil..
Department of Critical Care Medicine, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil..
Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada..
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada..
Pulmonary Engineering Group, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus and Technical University Dresden, Dresden, Germany..
Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital IRCCS for Oncology, University of Genoa, Genoa, Italy..
Nuffield Department of Medicine, University of Oxford, Oxford, UK..
Department of Intensive Care, University of Milan Bicocca, Monza, Italy..
Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy..
Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy..
Anaesthesia and Intensive Care Medicine, School of Medicine, National University of Ireland, and Galway University Hospitals Ireland, Galway, Ireland..
Regenerative Medicine Institute at CÚRAM Centre for Research in Medical Devices, National University of Ireland, and Galway University Hospitals Ireland, Galway, Ireland..
Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands..
Issue Date: Feb-2022
Date: 2022-02-22
Publication information: The Lancet. Global health 2022; 10(2): e227-e235
Abstract: Geoeconomic 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.
DOI: 10.1016/S2214-109X(21)00485-X
ORCID: 0000-0003-1520-9387
Journal: The Lancet. Global health
PubMed URL: 34914899
PubMed URL:
Type: Journal Article
Appears in Collections:Journal articles

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