Luigi PisaniAnna Geke AlgeraAry Serpa NetoAreef AhsanAbigail BeaneKaweesak ChittawatanaratAbul FaizRashan HaniffaSeyed Mohammad Reza HashemianMadiha HashmiHisham Ahmed ImadKanishka IndraratnaShivakumar IyerGyan KayasthaBhuvana KrishnaTai Li LingHassan MoosaBehzad NadjmRajyabardhan PattnaikSriram SampathLouise ThwaitesNi Ni TunNorazim Mohd YunosSalvatore GrassoFrederique PaulusMarcelo Gama de AbreuPaolo PelosiNick DayNicholas J. WhiteArjen M. DondorpMarcus J. SchultzUniversitätsklinikum Carl Gustav Carus DresdenFaculty of Tropical Medicine, Mahidol UniversityOxford University Clinical Research UnitIRCCS San Martino Polyclinic HospitalBharati Vidyapeeth Medical College, PuneIndira Gandhi Memorial Hospital MaleSri Jayewardenepura General HospitalIspat General HospitalThe Aga Khan UniversityBangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic DisordersKuala Lumpur HospitalUniversità degli Studi di GenovaUniversità degli studi di Bari Aldo MoroShahid Beheshti University of Medical SciencesHospital Israelita Albert EinsteinUniversity of Malaya Medical CentreNuffield Department of MedicineAmsterdam UMC - University of AmsterdamChiang Mai University19Medical Action MyanmarSt. John’s Medical CollegeDev Care FoundationPatan Academy of Health Sciences2022-08-042022-08-042021-03-01American Journal of Tropical Medicine and Hygiene. Vol.104, No.3 (2021), 1022-103314761645000296372-s2.0-85103166193https://repository.li.mahidol.ac.th/handle/20.500.14594/77317Epidemiology, ventilator management, and outcome in patients receiving invasive ventilation in intensive care units (ICUs) in middle-income countries are largely unknown. PRactice of VENTilation in Middle-income Countries is an international multicenter 4-week observational study of invasively ventilated adult patients in 54 ICUs from 10 Asian countries conducted in 2017/18. Study outcomes included major ventilator settings (including tidal volume [VT] and positive end-expiratory pressure [PEEP]); the proportion of patients at risk for acute respiratory distress syndrome (ARDS), according to the lung injury prediction score (LIPS), or with ARDS; the incidence of pulmonary complications; and ICU mortality. In 1,315 patients included, median VT was similar in patients with LIPS < 4 and patients with LIPS 3 4, but lower in patients with ARDS (7.90 [6.8–8.9], 8.0 [6.8–9.2], and 7.0 [5.8–8.4] mL/kg Predicted body weight; P = 0.0001). Median PEEP was similar in patients with LIPS < 4 and LIPS 3 4, but higher in patients with ARDS (five [5–7], five [5–8], and 10 [5–12] cmH2O; P < 0.0001). The proportions of patients with LIPS 3 4 or with ARDS were 68% (95% CI: 66–71) and 7% (95% CI: 6–8), respectively. Pulmonary complications increased stepwise from patients with LIPS < 4 to patients with LIPS 3 4 and patients with ARDS (19%, 21%, and 38% respectively; P = 0.0002), with a similar trend in ICU mortality (17%, 34%, and 45% respectively; P < 0.0001). The capacity of the LIPS to predict development of ARDS was poor (receiver operating characteristic [ROC] area under the curve [AUC] of 0.62, 95% CI: 0.54–0.70). In Asian middle-income countries, where two-thirds of ventilated patients are at risk for ARDS according to the LIPS and pulmonary complications are frequent, setting of VT is globally in line with current recommendations.Mahidol UniversityImmunology and MicrobiologyMedicineArticleSCOPUS10.4269/ajtmh.20-1177