| Contributors: |
Pisani, Luigi; Geke Algera, Anna; Serpa Neto, Ary; Azevedo, Luciano; Pham, T(\`(a))i; Paulus, Frederique; Gama De Abreu, Marcelo; Pelosi, Paolo; M Dondorp, Arjen; Bellani, Giacomo; G Laffey, John; J Schultz, Marcu; Martinez, Amadeu; Leal, Livia; Jorge Pereira, Antonio; De Oliveira Maia, Marcelo; Aires Neto, Jos(\`(e)); Piras, Claudio; Bernadete Caser, Eliana; Lavigne Moreira, Cora; Braga Gusman, Pablo; Moys('(e))s Dalcomune, Dyanne; Guilherme Ribeiro De Carvalho, Alexandre; Aline Rom(\~(a))o Gondim, Louise; Mariane Castelo Branco Reis, L('(\i))via; Da Cunha Ribeiro, Daniel; de Assis Sim(\~(o))es, Leonardo; Siqueira Campos, Rafaela; Carlos Fernandez Versiani Dos Anjos, Jos('(e)); Bruzzi Carvalho, Frederico; Ambrosio Alves, Rossine; Batista Nunes ('(A))lvaro R('(e))a-Neto, Lilian; Cristine De Oliveira, Mirella; Tannous, Luana; Cardoso Gomes, Brenno; Borges Rodriguez, Fernando; Abelha, Priscila; E Lugarinho, Marcelo; Japiassu, Andre; Konrad De Melo, H('(e))lder; Afonso Lopes, Elton; Varaschin, Pedro; C('(e))s de Souza Dantas, Vicente; Freitas Knibel, Marco; Ponte, Micheli; Mendes De Azambuja Rodrigues, Pedro; Carmo Costa Filho, Ruben; Saddy, Felipe; Forny Wanderley Castell(\~(o))es, Th('(e))ia; Alves Silva, Suzana; Antonio Gomes Osorio, Luiz; Mannarino, Dora; Espinoza, Rodolfo; Righy, Cassia; Soares, Marcio; Salluh, Jorge; Tanaka, Lilian; Arag(\~(a))o, Daniel; Eduarda Tavares, Maria; Goncalves Pereira Kehdi, Maura; Maria Campos Rezende, Val('(e))ria; Carlos Cruz Carbonell, Roberto; Teixeira, Cassiano; Pinheiro De Oliveira, Roselaine; Gasparetto Maccari, Ju(\c(c))ara; Souza Castro, Priscylla; Berto, Paula; Schwarz, Patricia; Peretti Torelly, Andr('(e)); Lisboa, Thiago; Moraes, Edison; Dal-Pizzol, Felipe; Tomasi Damiani, Cristiane; Ritter, Cristiane; Carvalho Ferreira, Juliana; Teixeira Costa, Ramon; Caruso, Pedro; Prata Amendola, Cristina; R De Oliveira, Amanda Maria R; A Silva, Ulysses V; Coelho Sanches, Luciana; S Almeida, Rosana D; Cesar Azevedo, Luciano; Park, Marcelo; Schettino, Guilherme; Santucci Assun(\c(c))(\~(a))o, Murillo; Silva, Eliezer; Eduardo Barboza, Carlo; Paulo Nassar Junior, Antonio; M Marzocchi Tierno, Paulo Fernando G; Marcelo Malbouisson, Lui; Oliveira, Luca; Cristovao, Davi; Leit(\~(a))o Neto (\^(E))nio Rego, Manoel; Eug(\^(e))nia Fernandes, Fernanda; Luz Pereira Romano, Marcelo; Biasi Cavalcanti, Alexandre; de Souza Barros ('(E))rica Aranha Suzumura, Dalton; Loureiro Meira, Karla; Affonso De Oliveira, Gustavo |
| Description: |
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 ... |