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
Issued Date
2022-02-01
Resource Type
eISSN
2214109X
Scopus ID
2-s2.0-85122926219
Pubmed ID
34914899
Journal Title
The Lancet Global Health
Volume
10
Issue
2
Start Page
e227
End Page
e235
Rights Holder(s)
SCOPUS
Bibliographic Citation
The Lancet Global Health Vol.10 No.2 (2022) , e227-e235
Suggested Citation
Pisani L. 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. The Lancet Global Health Vol.10 No.2 (2022) , e227-e235. e235. doi:10.1016/S2214-109X(21)00485-X Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/86162
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
Author(s)
Author's Affiliation
Universitätsklinikum Carl Gustav Carus Dresden
Mahidol Oxford Tropical Medicine Research Unit
Melbourne Medical School
IRCCS San Martino Polyclinic Hospital
Keenan Research Centre for Biomedical Science
University Hospital Galway
Monash University
University of Toronto
Hospital Israelita Albert Einstein
Azienda Ospedaliera San Gerardo Monza
Università degli Studi di Milano-Bicocca
Nuffield Department of Medicine
Universidade de São Paulo
Austin Hospital
Amsterdam UMC - University of Amsterdam
Australian New Zealand Intensive Care Research Centre
F. Miulli General Regional Hospital
Doctors with Africa CUAMM
Mahidol Oxford Tropical Medicine Research Unit
Melbourne Medical School
IRCCS San Martino Polyclinic Hospital
Keenan Research Centre for Biomedical Science
University Hospital Galway
Monash University
University of Toronto
Hospital Israelita Albert Einstein
Azienda Ospedaliera San Gerardo Monza
Università degli Studi di Milano-Bicocca
Nuffield Department of Medicine
Universidade de São Paulo
Austin Hospital
Amsterdam UMC - University of Amsterdam
Australian New Zealand Intensive Care Research Centre
F. Miulli General Regional Hospital
Doctors with Africa CUAMM
Other Contributor(s)
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 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.