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
Luigi Pisani, Anna Geke Algera, Ary Serpa Neto, Luciano César Pontes Azevedo, Tài Pham, Frederique Paulus, Marcelo Gama de Abreu, Paolo Pelosi, Arjen M. Dondorp, Giacomo Bellani, John G. Laffey, Marcus J. Schultz, Amadeu Martinez, Livia Leal, Antonio Jorge Pereira Júnior, Marcelo de Oliveira Maia, José Aires de Araújo Neto, Cláudio Piras, Eliana Bernadete Caser, Cora Lavigne Moreira, Pablo Braga Gusman, D. M. Dalcomune, Alexandre Carvalho, Louise Aline Romão Gondim, Lívia Mariane Castelo Branco Reis, Daniel da Cunha Ribeiro, Leonardo de Assis Simões, Rafaela Siqueira Campos, José Carlos Fernandez Versiani dos Anjos, Frederico Bruzzi de Carvalho, Rossine Ambrósio Alves, Lilian Batista Nunes, Álvaro Réa-Neto, Mirella Cristine de Oliveira, Luana Alves Tannous, Brenno Cardoso Gomes, Fernando Borges Rodriguez, Priscila Abelha, Marcelo E Lugarinho, André Miguel Japiassú, Hélder Konrad de Melo, Elton Afonso Lopes, Pedro Varaschin, Vicente Cés de Souza Dantas, Marcos Freitas Knibel, Micheli Ponte, Pedro Mendes de Azambuja Rodrigues, Rubens Costa Filho, Felipe Saddy, Théia Forny Wanderley Castellões, Suzana Alves Silva, Luiz Antonio Gomes Osorio, Dora Mannarino, Rodolfo Espinoza, Cássia Righy, Márcio Soares, Jorge I. Salluh, Lilian Maria Sobreira Tanaka, Daniel Aragão, Maria Eduarda Tavares, Maura Goncalves Pereira Kehdi, Valeria Rezende, Roberto Carlos Cruz Carbonell, Cassiano Teixeira, Roselaine Pinheiro de Oliveira, Juçara Gasparetto Maccari, Priscylla Souza Castro, Paula Pinheiro Berto, Patrícia Schwarz, André P. Torelly, Thiago Lisboa, Edison Moraes, Felipe Dal‐Pizzol, Cristiane Tomasi Damiani, Cristiane Ritter, Juliana Carvalho Ferreira, Ramon Teixeira Costa, Pedro Caruso, Cristina Prata Amêndola, Amanda Maria Ribas Rosa de Oliveira, Ulysses V A Silva, Luciana Coelho Sanches, Rosana D S Almeida, Luciano César Pontes Azevedo, Marcelo Park, Guilherme Schettino, Murillo Santucci César de Assunção, Eliezer Silva, Carlos Eduardo Galvão Barboza, Antônio Paulo Nassar, Paulo F. G. M. M. Tierno, Luis Marcelo Malbouisson, Lucas Oliveira, Davi Cristovao, M L Neto, Ênio Rego, Fernanda Eugênia Fernandes, Marcelo Luz Pereira Romano, Alexandre Biasi Cavalcanti, Dalton de Souza Barros
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: 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.