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
(2022) In The Lancet Global Health 10(2). p.227-235- Abstract
Background: 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. Methods: 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... (More)
Background: 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. Methods: 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. Findings: 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). Interpretation: 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. Funding: No funding.
(Less)
- author
- contributor
- Kander, Thomas
LU
- author collaboration
- organization
- publishing date
- 2022-02-01
- type
- Contribution to journal
- publication status
- published
- subject
- in
- The Lancet Global Health
- volume
- 10
- issue
- 2
- pages
- 227 - 235
- publisher
- Lancet Publishing Group
- external identifiers
-
- pmid:34914899
- scopus:85122926219
- ISSN
- 2214-109X
- DOI
- 10.1016/S2214-109X(21)00485-X
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
- id
- 6137e451-948a-47ba-b6b2-25e23ea7d29c
- date added to LUP
- 2023-11-12 19:10:18
- date last changed
- 2024-04-24 10:44:42
@article{6137e451-948a-47ba-b6b2-25e23ea7d29c,
abstract = {{<p>Background: 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. Methods: 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. Findings: 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 H<sub>2</sub>O; 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). Interpretation: 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. Funding: No funding.</p>}},
author = {{Pisani, Luigi and Algera, Anna Geke and Neto, Ary Serpa and Azevedo, Luciano Cesar and Pham, Tài and Paulus, Frederique and de Abreu, Marcelo Gama and Pelosi, Paolo and Dondorp, Arjen M. and Bellani, Giacomo and Laffey, John G. and Schultz, Marcus J. and Martinez, Amadeu and Leal, Livia and Jorge Pereira, Antonio and de Oliveira Maia, Marcelo and Neto, Josè Aires and Piras, Claudio and Caser, Eliana Bernadete and Moreira, Cora Lavigne and Braga Gusman, Pablo and Dalcomune, Dyanne Moysés and Ribeiro de Carvalho, Alexandre Guilherme and Gondim, Louise Aline Romão and Castelo Branco Reis, Lívia Mariane and da Cunha Ribeiro, Daniel and de Assis Simões, Leonardo and Campos, Rafaela Siqueira and Fernandez Versiani dos Anjos, José Carlos and Bruzzi Carvalho, Frederico and Alves, Rossine Ambrosio and Nunes, Lilian Batista and Réa-Neto, Álvaro and de Oliveira, Mirella Cristine and Tannous, Luana and Cardoso Gomes, Brenno and Rodriguez, Fernando Borges and Abelha, Priscila and Larsson, Anders and Liu, Haitao and Wang, Wei and Zhang, Fan and Liu, Jian and Li, Bin and Liu, Jing L. and Li, Yuan Y. and Oliveira, Bruno S. and Larsson, Niklas and Smith, Roger}},
issn = {{2214-109X}},
language = {{eng}},
month = {{02}},
number = {{2}},
pages = {{227--235}},
publisher = {{Lancet Publishing Group}},
series = {{The Lancet Global Health}},
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}},
url = {{http://dx.doi.org/10.1016/S2214-109X(21)00485-X}},
doi = {{10.1016/S2214-109X(21)00485-X}},
volume = {{10}},
year = {{2022}},
}