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.
| Autor: | Pisani L; 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. Electronic address: luigipisani@gmail.com., Algera AG; Department of Intensive Care, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands., Neto AS; School of Public Health and Preventive Medicine, Monash University, Australian; New Zealand Intensive Care Research Centre, Melbourne, VIC, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia; Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, VIC, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil., Azevedo L; Department of Critical Care Medicine, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Pham T; 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., Paulus F; Department of Intensive Care, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands., de Abreu MG; Pulmonary Engineering Group, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus and Technical University Dresden, Dresden, Germany., Pelosi P; Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital IRCCS for Oncology, University of Genoa, Genoa, Italy., Dondorp AM; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK., Bellani G; 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., Laffey JG; 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., Schultz MJ; Department of Intensive Care, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands; Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK. |
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| Jazyk: | angličtina |
| Zdroj: | The Lancet. Global health [Lancet Glob Health] 2022 Feb; Vol. 10 (2), pp. e227-e235. Date of Electronic Publication: 2021 Dec 13. |
| DOI: | 10.1016/S2214-109X(21)00485-X |
| Abstrakt: | 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 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. Competing Interests: Declaration of interests We declare no competing interests. (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.) |
| Databáze: | MEDLINE |
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