John G Laffey1, Fabiana Madotto2, Giacomo Bellani3, Tài Pham4, Eddy Fan5, Laurent Brochard6, Pravin Amin7, Yaseen Arabi8, Ednan K Bajwa9, Alejandro Bruhn10, Vladimir Cerny11, Kevin Clarkson12, Leo Heunks13, Kiyoyasu Kurahashi14, Jon Henrik Laake15, Jose A Lorente16, Lia McNamee17, Nicolas Nin18, Jose Emmanuel Palo19, Lise Piquilloud20, Haibo Qiu21, Juan Ignacio Silesky Jiménez22, Andres Esteban18, Daniel F McAuley17, Frank van Haren23, Marco Ranieri24, Gordon Rubenfeld25, Hermann Wrigge26, Arthur S Slutsky6, Antonio Pesenti27. 1. Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada; Department of Critical Care Medicine, St Michael's Hospital, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesia, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: laffeyj@smh.ca. 2. Research Center on Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. 3. Research Center on Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy. 4. 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; Sorbonne Universités, UPMC Université Paris 06, Paris, France. 5. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada. 6. 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. 7. Department of Critical Care Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, India. 8. Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Respiratory Services, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. 9. Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 10. Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 11. Department of Anesthesiology, Perioperative Medicine and Intensive Care, J E Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic; Department of Research and Development, and Department of Anesthesiology and Intensive Care, Charles University in Prague, Prague, Czech Republic; Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic. 12. Department of Anaesthesia, Galway University Hospitals and National University of Ireland, Galway, Galway, Ireland. 13. Department of Intensive Care, VU University Medical Centre Amsterdam, Netherlands. 14. Department of Anesthesiology and Intensive Care Medicine, School of Medicine, International University of Health and Welfare, Narita, Japan. 15. Division of Critical Care, Department of Anaesthesiology, Rikshospitalet Medical Centre, Oslo University Hospital, Oslo, Norway. 16. CIBER de Enfermedades Respiratorias, Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain. 17. Centre for Experimental Medicine, Queen's University of Belfast, Belfast, Northern Ireland, UK; Wellcome-Wolfson Institute for Experimental Medicine, Belfast, Northern Ireland, UK; Regional Intensive Care Unit, Royal Victoria Hospital A&E, Grosvenor Road, Belfast, Northern Ireland, UK. 18. CIBER de Enfermedades Respiratorias, Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain; Hospital Español, Montevideo, Uruguay. 19. Section of Adult Critical Care, Department of Medicine, The Medical City, Pasig, Philippines. 20. Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland; Department of Medical Intensive Care, University Hospital of Angers, Angers, France. 21. Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China. 22. Department of Intensive Care, Hospital San Juan de Dios, and Department of Intensive Care, Hospital CIMA San Jose, Council of Critical Medicine, University of Costa Rica, San Pedro Montes de Oca, Costa Rica. 23. Intensive Care Unit, Canberra Hospital, Canberra, ACT, Australia; Australian National University, Canberra, ACT, Australia. 24. Sapienza Università di Roma, Dipartimento di Anestesia e Rianimazione, Policlinico Umberto I, Rome, Italy. 25. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Program in Trauma, Emergency and Critical Care, Sunnybrook Health Sciences Center, Toronto, ON, Canada. 26. Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany. 27. Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico and Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
Abstract
BACKGROUND: Little information is available about the geo-economic variations in demographics, management, and outcomes of patients with acute respiratory distress syndrome (ARDS). We aimed to characterise the effect of these geo-economic variations in patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE). METHODS: LUNG SAFE was done during 4 consecutive weeks in winter, 2014, in a convenience sample of 459 intensive-care units in 50 countries across six continents. Inclusion criteria were admission to a participating intensive-care unit (including transfers) within the enrolment window and receipt of invasive or non-invasive ventilation. One of the trial's secondary aims was to characterise variations in the demographics, management, and outcome of patients with ARDS. We used the 2016 World Bank countries classification to define three major geo-economic groupings, namely European high-income countries (Europe-High), high-income countries in the rest of the world (rWORLD-High), and middle-income countries (Middle). We compared patient outcomes across these three groupings. LUNG SAFE is registered with ClinicalTrials.gov, number NCT02010073. FINDINGS: Of the 2813 patients enrolled in LUNG SAFE who fulfilled ARDS criteria on day 1 or 2, 1521 (54%) were recruited from Europe-High, 746 (27%) from rWORLD-High, and 546 (19%) from Middle countries. We noted significant geographical variations in demographics, risk factors for ARDS, and comorbid diseases. The proportion of patients with severe ARDS or with ratios of the partial pressure of arterial oxygen (PaO2) to the fractional concentration of oxygen in inspired air (FiO2) less than 150 was significantly lower in rWORLD-High countries than in the two other regions. Use of prone positioning and neuromuscular blockade was significantly more common in Europe-High countries than in the other two regions. Adjusted duration of invasive mechanical ventilation and length of stay in the intensive-care unit were significantly shorter in patients in rWORLD-High countries than in Europe-High or Middle countries. High gross national income per person was associated with increased survival in ARDS; hospital survival was significantly lower in Middle countries than in Europe-High or rWORLD-High countries. INTERPRETATION: Important geo-economic differences exist in the severity, clinician recognition, and management of ARDS, and in patients' outcomes. Income per person and outcomes in ARDS are independently associated. FUNDING: European Society of Intensive Care Medicine, St Michael's Hospital, University of Milan-Bicocca.
BACKGROUND: Little information is available about the geo-economic variations in demographics, management, and outcomes of patients with acute respiratory distress syndrome (ARDS). We aimed to characterise the effect of these geo-economic variations in patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE). METHODS: LUNG SAFE was done during 4 consecutive weeks in winter, 2014, in a convenience sample of 459 intensive-care units in 50 countries across six continents. Inclusion criteria were admission to a participating intensive-care unit (including transfers) within the enrolment window and receipt of invasive or non-invasive ventilation. One of the trial's secondary aims was to characterise variations in the demographics, management, and outcome of patients with ARDS. We used the 2016 World Bank countries classification to define three major geo-economic groupings, namely European high-income countries (Europe-High), high-income countries in the rest of the world (rWORLD-High), and middle-income countries (Middle). We compared patient outcomes across these three groupings. LUNG SAFE is registered with ClinicalTrials.gov, number NCT02010073. FINDINGS: Of the 2813 patients enrolled in LUNG SAFE who fulfilled ARDS criteria on day 1 or 2, 1521 (54%) were recruited from Europe-High, 746 (27%) from rWORLD-High, and 546 (19%) from Middle countries. We noted significant geographical variations in demographics, risk factors for ARDS, and comorbid diseases. The proportion of patients with severe ARDS or with ratios of the partial pressure of arterial oxygen (PaO2) to the fractional concentration of oxygen in inspired air (FiO2) less than 150 was significantly lower in rWORLD-High countries than in the two other regions. Use of prone positioning and neuromuscular blockade was significantly more common in Europe-High countries than in the other two regions. Adjusted duration of invasive mechanical ventilation and length of stay in the intensive-care unit were significantly shorter in patients in rWORLD-High countries than in Europe-High or Middle countries. High gross national income per person was associated with increased survival in ARDS; hospital survival was significantly lower in Middle countries than in Europe-High or rWORLD-High countries. INTERPRETATION: Important geo-economic differences exist in the severity, clinician recognition, and management of ARDS, and in patients' outcomes. Income per person and outcomes in ARDS are independently associated. FUNDING: European Society of Intensive Care Medicine, St Michael's Hospital, University of Milan-Bicocca.
Authors: Edward J Schenck; Clara Oromendia; Lisa K Torres; David A Berlin; Augustine M K Choi; Ilias I Siempos Journal: Chest Date: 2018-10-22 Impact factor: 9.410
Authors: Robinder G Khemani; Lincoln Smith; Yolanda M Lopez-Fernandez; Jeni Kwok; Rica Morzov; Margaret J Klein; Nadir Yehya; Douglas Willson; Martin C J Kneyber; Jon Lillie; Analia Fernandez; Christopher J L Newth; Philippe Jouvet; Neal J Thomas Journal: Lancet Respir Med Date: 2018-10-22 Impact factor: 30.700
Authors: Abhishek Jha; Francesco Vasques; Barnaby Sanderson; Kathleen Daly; Guy Glover; Nicholas Ioannou; Duncan Wyncoll; Peter Sherren; Chris Langrish; Chris Meadows; Andrew Retter; Richard Paul; Nicholas A Barrett; Luigi Camporota Journal: J Intensive Care Soc Date: 2020-06-01