Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study

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      • John G. Laffey
      • Fabiana Madotto
      • Giacomo Bellani
      • Tài Pham
      • Eddy Fan
      • Laurent Brochard
      • Pravin Amin
      • Yaseen M Arabi
      • Ednan K Bajwa
      • Alejandro Bruhn
      • Vladimir Cerny
      • Kevin Clarkson
      • Leo M Heunks
      • Kiyoyasu Kurahashi
      • Jon Henrik Laake
      • Jose A. Lorente
      • Lia McNamee
      • Nicolas Nin
      • Jose Emmanuel Palo
      • Lise Piquilloud
      • Haibo Qiu
      • Juan Ignacio Silesky Jiménez
      • Andres Esteban
      • Daniel F. McAuley
      • Frank van Haren
      • Marco Ranieri
      • Gordon D. Rubenfeld
      • Hermann Wrigge
      • Arthur S. Slutsky
      • Antonio Pesenti

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      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.

      DOI

      Original languageEnglish
      Number of pages12
      Pages (from-to)627-638
      JournalThe Lancet Respiratory Medicine
      Journal publication date01 Aug 2017
      Issue number8
      Volume5
      Early online date14 Jun 2017
      DOIs
      StatePublished - 01 Aug 2017

      ID: 133365125