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

Authors: 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, Érica Aranha Suzumura, Karla Loureiro Meira, Gustavo Affonso de Oliveira, Paula Menezes Luciano, Evelin Drociunas Pacheco, Bruno Franco Mazza, Flávia Ribeiro Machado, Elaine Maria Ferreira, Ronaldo B. Santos, Alexandra Siqueira Colombo, Antônio Carlos Nogueira, Juliana Baroni Fernandes, Raquel Siqueira Nóbrega, Barbara do CS Martins, Francisco García Soriano, Rafaela Deczka Morsch, André Luiz Baptiston Nunes, Juliano Pinheiro de Almeida, Ludhmila Abrahão Hajjar, Sílvia Moulin, Fabio Giannini, André Luiz Baptiston Nunes, Fernando Ríos, Frank van Haren, Thierry Sottiaux, Fredy S Lora, Luciano C. P. Azevedo, Pieter Depuydt, Eddy Fan, Guillermo Bugedo, Haibo Qiu, Marcos Gonzalez, Juan Silesky, Vladimír Černý, Jonas Nielsen, Manuel Jibaja, Tài Pham, Hermann Wrigge, Dimitrios Matamis, Jorge Luis Ranero, Seyed Mohammad Reza Hashemian, Pravin Amin, Kevin Clarkson, Giacomo Bellani, Kiyoyasu Kurahashi, Asisclo Villagómez, Amine Ali Zeggwagh, Leo Heunks, Jon Henrik Laake, Jose Emmanuel Palo, Antero Fernandes, Dorel Săndesc, Yaasen Arabi, Vesna Bumbasierevic, José A. Lorente, Anders Larsson, Lise Piquilloud, Fekri Abroug, Daniel F. McAuley, Lia McNamee, Javier Hurtado, Ednan K. Bajwa, Gabriel D’Empaire, Guy François, Hektor Sula, Lordian Nunci, Alma Cani, Alan Zazu, Christian Dellera, Carolina S. Insaurralde, Risso V Alejandro, Julio Daldin, Mauricio Vinzio, Ruben O Fernandez, Luis Pablo Cardonnet, Lisandro Roberto Bettini, Mariano Carboni Bisso, Emilio M. Osman, Mariano Setten, Pablo Lovazzano, Javier Álvarez, Veronica Villar, César Milstein, Norberto C. Pozo, Nicolas Grubissich, Gustavo Plotnikow, Daniela N. Vásquez, Santiago Ilutovich, Norberto Tiribelli, Ariel Chena, Carlos A. Pellegrini, María G. Sáenz, Elisa Estenssoro, Matías Brizuela, Hernan Gianinetto, Pablo Gómez, Valeria I. Cerrato, Marco Bezzi, Silvina Borello, Flavia A. Loiacono, Adriana Fernández, Serena Knowles, Claire Reynolds, Deborah Inskip, Jennene Miller, Jing Kong, Christina Whitehead, Shailesh Bihari, Aylin Seven, Amanda Krstevski, Helen Rodgers, Rebecca T. Millar, Toni McKenna, Irene M Bailey, Gabrielle C Hanlon, Anders Åneman, Joan Lynch, Raman Azad, John Neal, Paul W. Woods, Brigit Roberts, Mark Kol, Helen S. Wong, Katharina Riss, Thomas Staudinger, Xavier Wittebole, Caroline Berghe, Pierre Bulpa, Alain Dive, Rik Verstraete, Herve Lebbinck, Pieter Depuydt, Joris Vermassen, Philippe Meersseman, Helga Ceunen, Jonas I Rosa, Daniel O. Beraldo, Cláudio Piras, Adenilton M R Ampinelli, Antônio Paulo Nassar, Sergio Mataloun, Marcelo Moock, Marlus M. Thompson, Claudio H. Gonçalves, Ana Carolina Peçanha Antônio, Aline Maria Ascoli, Rodrigo Biondi, Danielle C. Fontenele, Danielle Nóbrega, Vanessa M. Sales, Suresh Shindhe, Dk Maizatul Aiman B Pg Hj Ismail, John G. Laffey, François Beloncle, Kyle G. Davies, Rob Cirone, Venika Manoharan, Mehvish Ismail, Ewan C. Goligher, Mandeep Jassal, Erin Nishikawa, Areej Javeed, Gerard F. Curley, Nuttapol Rittayamai, Matteo Parotto, Niall D. Ferguson, Sangeeta Mehta, Jenny Knoll, Antoine Pronovost, Sergio Canestrini, Alejandro Bruhn, Patricio García, Felipe Aliaga, Pamela A. Farías, Jacob Yumha, Claudia A Ortiz, Javier Salas, Alejandro A Saez, Luis Diego Solano Vega, Eduardo F. Labarca, Felipe Martínez, Nicolás Carreño, Pilar Lora, Haitao Liu, Haibo Qiu, Ling Liu, Rui Tang, Xiaoming Luo, Youzhong An, Huiying Zhao, Yan Gao, Zhe Zhai, Zheng Ye, Wei Wang, Wenwen Li, Qingdong Li, Ruiqiang Zheng, Wenkui Yu, Juanhong Shen, Xinyu Li, Tao Yu, Weihua Lü, Ya Wu, Xiao Huang, Zhenyang He, Yuanhua Lu, Hui Han, Fan Zhang, Renhua Sun, Hua Wang, Shu H. Qin, Bao H. Zhu, Jun Zhao, Jian Liu, Bin Li, Jing Liu, Fa C. Zhou, Qiong Li, Xing Zhang, Zhou Li-xin, Qiang Xin-Hua, Liangyan Jiang, Yuan Gao, Xian Zhao, Yuan Li, Xiao L Li, Chunting Wang, Qingchun Yao, Rongguo Yu, Kai Chen, Huanzhang Shao, Bingyu Qin, Qing Q. Huang, Wei Zhu, Ai Y. Hang, Ma X Hua, Yimin Li, Yonghao Xu, Yu D. Di, Long L. Ling, Tie H Qin, Wang Shou, Jun‐Ping Qin, Yifan Han, Suming Zhou, Monica P. Vargas, Juan Ignacio Silesky Jiménez, Manuel Rojas, Jaime E Solis-Quesada, Christian M. Ramirez-Alfaro, Jan Máca, Peter Sklienka, Jakob Gjedsted, Aage Christiansen, Jonas Nielsen, Boris Villamagua, Miguel Llano, Philippe Burtin, Gautier Buzancais, Pascal Beuret, Nicolas Pelletier, Satar Mortaza, Alain Mercat, Jonathan Chelly, Sébastien Jochmans, Nicolas Terzi, Cédric Daubin, Guillaume Carteaux, Nicolas de Prost, Jean‐Daniel Chiche, Fabrice Daviaud, Tài Pham, Muriel Fartoukh, Guillaume Barberet, Jérome Biehler, Jean Dellamonica, Denis Doyen, Jean-Michel Arnal, Anaïs Briquet, Sami Hraiech, Laurent Papazian, Arnaud Follin, Damien Roux, Jonathan Messika, Evangelos Kalaitzis, Laurence Dangers, Alain Combes, Siu-Ming Au, G. Béduneau, Dorothée Carpentier, Elie H. Zogheib, Hervé Dupont, Sylvie Ricôme, Francesco Santoli, Sébastien Besset, P. Michel, Bruno Gelée, Pierre-Éric Danin, B. Goubaux, Philippe J. Crova, Nga T. Phan, Frantz Berkelmans, Julio Badié, Romain Tapponnier, Josette Gally, Samy Khebbeb, Jean-Étienne Herbrecht, Francis Schneider, Pierre-Louis Declercq, Jean‐Philippe Rigaud, Jacques Duranteau, Anatole Harrois, Russell Chabanne, Julien Marin, Charlene Bigot, Sandrine Thibault, Mohammed Ghazi, Messabi Boukhazna, Salem Ould Zein, Jack Richecoeur, Danièle Combaux, Fabien Grelon, Charlène Le Moal, Elise Sauvadet, Adrien Robine, Virginie Lemiale, Danielle Reuter, Martin Dres, Alexandre Demoule, Dany Goldgran-Tolédano, Loredana Baboi, Claude Guérin, Ralph Lohner, Jens Kraßler, Susanne Schäfer, Kai Zacharowski, Patrick Meybohm, Andreas W. Reske, Philipp Simon, Hans-Bernd Hopf, Michael Schuetz, Thomas Baltus, Metaxia Papanikolaou, Theonymfi Papavasilopoulou, Giannis A Zacharas, Vasilis Ourailogloy, Eleni Mouloudi, Eleni Massa, Eva Nagy, Eleftheria Stamou, Ellada Kiourtzieva, Marina Oikonomou, Luis Eduardo López Ávila, Cesar A. Cortez, Johanna E. Citalán, Sameer Jog, Safal Sable, Bhagyesh Shah, Mohan Gurjar, Arvind Baronia, Mohammedfaruk Memon, Radhakrishnan Muthuchellappan, Venkatapura J. Ramesh, Anitha Shenoy, Ramesh Unnikrishnan, Subhal Dixit, Rachana V Rhayakar, Nagarajan Ramakrishnan, Vallish K Bhardwaj, Heera Lal Mahto, Sudha V. Sagar, Vijayanand Palaniswamy, Deeban Ganesan, Seyed Mohammad Reza Hashemian, Hamidreza Jamaati, Farshad Heidari‐Beni, Edel A. Meaney, Alistair Nichol, Karl M. Knapman, Dónall O'Croínin, Éimhín Dunne, Dorothy Breen, Kevin Clarkson, Rola Jaafar, Rory Dwyer, Fahd Amir, Olaitan O. Ajetunmobi, Aogan C. O’Muircheartaigh, Colin Black, Nuala Treanor, Daniel Collins, Wahid Altaf, Gianluca Zani, Maurizio Fusari, Savino Spadaro, Carlo Alberto Volta, Romano Graziani, Barbara Brunettini, Salvatore Palmese, Paolo Formenti, Michele Umbrello, Andrea Lombardo, Elisabetta Pecci, Marco Botteri, M. Savioli, Alessandro Protti, Alessia Mattei, Lorenzo Schiavoni, Andrea Tinnirello, Manuel Todeschini, Antonino Giarratano, Andrea Cortegiani, Sara Sher, Anna Rossi, Massimo Antonelli, Luca M. Montini, Paolo Casalena, Sergio Scafetti, Giovanna Panarello, Giovanna Occhipinti, Nicolò Patroniti, Matteo Pozzi, Roberto R Biscione, Michela M. 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Parhar, Latha Srinivasa, Lia McNamee, Danny McAuley, Jack Steinberg, Philip Hopkins, Clare Mellis, Frank Stansil, Vivek Kakar, Dan Hadfield, Christine Brown, André Vercueil, Kaushik Bhowmick, Sally Humphreys, Andrew Ferguson, Raymond McKee, Ashok Raj, Danielle A Fawkes, Philip Watt, Linda Twohey, Rajeev R Jha Matthew Thomas, Alex Morton, Varsha Kadaba, Mark Smith, Anil Hormis, S. 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Oliveira, Carlos Airton Severo Munhoz, Ana Carolina Peçanha, Fernando José da Silva Ramos, Israel Silva Maia, Marina Bahl, Rodrigo Biondi, Daniel Prado, Sérgio Felix Pinto, Jean Charles Monteiro Salgado, Luis Fernando Falcão, Tiago de Almeida Macruz, Alexandre Biasi Cavalcanti, Marcelo Luz Pereira Romano, Kessia Ruas, Giovana Colozza Mecatti, Eliane Bernadete Caser, Isabela Ambrósio Gava, Nicolás Carreño, Mauricio Morales, Rossana Avendaño, Stefania Aguirre, Andrej Šribar, Vlasta Klarić, Sonja Skilijic, Matea Bogdanović Dvorščak, Marijana Krkusek, Matija Jurjević, Nenad Karanović, Tatjana Śimurina, Petr Štourač, Milan Kratochvíl, Jan Máca, Hermann Wrigge, Christian Schlegel, Tanja A. Treschan, Maximilian S. 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Tarmey, John Knighton, Julian Giles, Debbie Weller, Isabelle Reed, Anil Hormis, Sallyane Pearson, Meredith Harris, Jo-Anne Howe, Jonathan Paddle, Karen Burt, Ingeborg Welters, Anna Walker, Laura Youds, Sam Hendry, David M. Shaw, Karen Williams, Robin Hollands, Mandy Carnahan, Johanna Stickley, Claire Miller, Denise Donaldson, Louise Tonks, Ben Creagh‐Brown, Daniel Hull, Owen Boyd, Laura Ortiz-Ruiz, Shammer Gopal, Stella Metherell, Hazel Spencer, Christian Frey, Carly Brown, Gayle Clifford, Susannah Leaver, Christine Ryan, Johannes Mellinghoff, S. Prudden, Helen Green Green, Alistair Roy, Julie Furneval, Adam Bell Bell, Sandeep Lakhani, Lousie Fasting Fasting, Lorna Murray, Kobus Preller, Amy McInerney, Sarah Beavis, Amanda Whileman, Julie Toms, Sue Glenn, Mohamed Ramali, Alison Ghosh, Clare Bullock, Lisa Barrell, Eoin Young, Helen Robertson, Maria Faulkner, Peter Macnaughton, Susan Tyson, Paul Pulak, Terri-Ann Sewell, Christopher Smalley, Reni Jacob, Cristina Santos, Pedro Alzugaray, Marcos F. Vidal Melo, Kristen Joyce, Joseph S. Needleman, Areef Ahsan, Abul Faiz, AKM Shamsul Alam, Syeda Nafisa Khatoon, Ranjan Kumer Nath, Mohammed Abdur Rahman Chowdhury, Debabrata Banik, Montosh Kumar Mondol, Sakibur Rahman Bhuiyan, Suraiya Nazneed, Rozina Sultana, Tarikul Hamid, Mozaffer Hossain, Syed Tariq Reza, Muhammad Asaduzzaman, Mohammad Salim, Abu Hena Mostafa Kamal, Sheikh Mohammed Taher, Taohidul Majid Taohid, Pranab Karmaker, Sabyasachi Roy, Shantanu Das, Sohel Ahmed Sarkar, Monju Lal Dutta, Poulomi Roy, Shivakumar Iyer, Bhuvana Krishna, Sriram Sampath, Rajyabardhan Pattnaik, Chinni Krishna Kasi, Jignesh Shah, Anand Dongre, Seyed Mohammad Reza Hashemian, Navid Nooraei, Reza Raessi Estabragh, Majid Malekmohammad, Batoul Khoundabi, Maziar Mobasher, Nor’azim Mohd Yunos, Mahazir Kassim, Chern Min Voon, Stanis Sutharsa Das, Siti Nur Suhaila Azauddin, Dharshinie Dorasamy, Li Ling Tai, Mohd Basri Mat Nor, Nurhafizah Zarudin, Mohd Shahnaz Hasan, Mohamad Fadhil Hadi Jamaluddin, Mohamad Irfan Othman Jailani, Gyan Krishna Kayashta, Aaradhana Adhikari, Raju Pangeni, Madiha Hashmi, Sonia Joseph, Aftab Akhtar, Aayesha Qadeer, Iqbal Memon, Syed Muneeb Ali, Farah Idrees, Saima Kamal, Sadaf Hanif, Atta Ur Rehman, Arshad Taqi, Tanveer Hussain, Ahmed Farooq, Saleh Khaskheli, Muhammad Hayat, Kanishka Indraratna, Abi Beane, Rashan Haniffa, Upeka Samaranayake, Sathiyamoorthy Mathanalagan, Asoka Gunaratne, Nimangee Wathsala Mithraratne, Kaushila Thilakasiri, Chamila Pilimatalawwe, Y A Hasitha Dilhani, Marie Fernando, Kumudini Ranatunge, Loranthi Samarasinghe, Manori Vaas, Manoj Edirisooriya, Chathurani Sigera, Janaki Arumoli, Kesharie De Silva, Bimal Kudavidanage, V G S Pinto, Lakshman Dissanayake, Kaweesak Chittawatanarat, Napplika Kongpolprom, Udomsak Silachamroon, Prapaporn Pornsuriyasak, Tananchai Petnak, Pongsasit Singhatas, Viratch Tangsujaritvijit, Suthat Rungruanghiranya, Annop Piriyapatsom, Kanokkarn Juntaping, Konlawij Trongtrakul, Poungrat Thungtitigul, Pattraporn Tajarernmuang, Sunisa Chatmongkolchart, Rungsun Bhurayanontachai, Osaree Akaraborworn, Asma Navasakulpong, Karjbundid Surasit, Louise Thwaites, Behzad Nadjm, Dat Vu Quoc, Hà Nguyễn Thanh, Kính Nguyen Văn, Thuy Duong Bich, Yen Lam Minh - The Lancet 2021 cited by 45

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.