TY - JOUR
T1 - Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome
T2 - insights from the LUNG SAFE prospective cohort study
AU - Laffey, John G.
AU - Madotto, Fabiana
AU - Bellani, Giacomo
AU - Pham, Tài
AU - Fan, Eddy
AU - Brochard, Laurent
AU - Amin, Pravin
AU - Arabi, Yaseen
AU - Bajwa, Ednan K.
AU - Bruhn, Alejandro
AU - Cerny, Vladimir
AU - Clarkson, Kevin
AU - Heunks, Leo
AU - Kurahashi, Kiyoyasu
AU - Laake, Jon Henrik
AU - Lorente, Jose A.
AU - McNamee, Lia
AU - Nin, Nicolas
AU - Palo, Jose Emmanuel
AU - Piquilloud, Lise
AU - Qiu, Haibo
AU - Jiménez, Juan Ignacio Silesky
AU - Esteban, Andres
AU - McAuley, Daniel F.
AU - van Haren, Frank
AU - Ranieri, Marco
AU - Rubenfeld, Gordon
AU - Wrigge, Hermann
AU - Slutsky, Arthur S.
AU - Pesenti, Antonio
AU - LUNG SAFE Investigators
AU - ESICM Trials Group
AU - Gattinoni, Luciano
AU - Larsson, Anders
AU - Thompson, B. Taylor
AU - Rios, Fernando
AU - Sottiaux, Thierry
AU - Depuydt, Pieter
AU - Lora, Fredy S.
AU - Azevedo, Luciano C.
AU - Bugedo, Guilliermo
AU - González, Marcos
AU - Silesky, Juan
AU - Nielsen, Jonas
AU - Jibaja, Manuel
AU - Matamis, Dimitrios
AU - Ranero, Jorge L.
AU - Hashemian, S. M.
AU - Villagomez, Asisclo
AU - Zeggwagh, Amine Ali
AU - Fernandes, Antero do Vale
AU - Sandesc, Dorel
AU - Bumbasierevic, Vesna
AU - Abroug, Fekri
AU - Hurtado, Javier
AU - Démpaire, Gabriel
AU - Sula, Hektor
AU - Nunci, Lordian
AU - Cani, Alma
AU - Zazu, Alan
AU - Dellera, Christian
AU - Alejandro, Risso V.
AU - Daldin, Julio
AU - Fernandez, Ruben O.
AU - Cardonnet, Luis P.
AU - Bettini, Lisandro R.
AU - Bisso, Mariano Carboni
AU - Osman, Emilio M.
AU - Setten, Mariano G.
AU - Lovazzano, Pablo
AU - Alvarez, Javier
AU - Villar, Veronica
AU - Pozo, Norberto C.
AU - Grubissich, Nicolas
AU - Plotnikow, Gustavo A.
AU - Vasquez, Daniela N.
AU - Ilutovich, Santiago
AU - Tiribelli, Norberto
AU - Chena, Ariel
AU - Pellegrini, Carlos A.
AU - Saenz, María G.
AU - Estenssoro, Elisa
AU - Brizuela, Matias
AU - Gianinetto, Hernan
AU - Gomez, Pablo E.
AU - Cerrato, Valeria I.
AU - Bezzi, Marco G.
AU - Borello, Silvina A.
AU - Loiacono, Flavia A.
AU - Fernandez, Adriana M.
AU - Knowles, Serena
AU - Reynolds, Claire
AU - Inskip, Deborah M.
AU - Miller, Jennene J.
AU - Kong, Jing
AU - Whitehead, Christina
AU - Bihari, Shailesh
AU - Seven, Aylin
AU - Krstevski, Amanda
AU - Rodgers, Helen
AU - Millar, Rebecca
AU - Mckenna, Toni
AU - Bailey, Irene
AU - Hanlon, Gabrielle
AU - Aneman, Anders
AU - Lynch, Joan
AU - Azad, Raman
AU - Neal, John
AU - Woods, Paul
AU - Roberts, Brigit
AU - Kol, Mark
AU - Wong, Helen
AU - Riss, Katharina
AU - Staudinger, Thomas
AU - Wittebole, Xavier
AU - Berghe, Caroline
AU - Bulpa, Pierre
AU - Dive, Alain
AU - Verstraete, Rik
AU - Lebbinck, Herve
AU - Vermassen, Joris
AU - Meersseman, Philippe
AU - Ceunen, Helga
AU - Rosa, Jonas
AU - Beraldo, Daniel
AU - Piras, Claudio
AU - Rampinelli, Adenilton
AU - Nassar, Antonio
AU - Mataloun, Sergio
AU - Moock, Marcelo
AU - Thompson, Marlus
AU - Gonçalves, Claudio
AU - Antônio, Ana
AU - Ascoli, Aline
AU - Biondi, Rodrigo
AU - Fontenele, Danielle
AU - Nobrega, Danielle
AU - Sales, Vanessa
AU - Shindhe, Suresh
AU - Ismail, Dk
AU - Beloncle, Francois
AU - Davies, Kyle
AU - Cirone, Rob
AU - Manoharan, Venika
AU - Ismail, Mehvish
AU - Goligher, Ewan
AU - Jassal, Mandeep
AU - Nishikawa, Erin
AU - Javeed, Areej
AU - Curley, Gerard
AU - Rittayamai, Nuttapol
AU - Parotto, Matteo
AU - Ferguson, Niall
AU - Mehta, Sangeeta
AU - Knoll, Jenny
AU - Pronovost, Antoine
AU - Canestrini, Sergio
AU - Garcia, Patricio
AU - Aliaga, Felipe
AU - Farías, Pamela
AU - Yumha, Jacob
AU - Ortiz, Claudia
AU - Salas, Javier
AU - Saez, Alejandro
AU - Vega, Luis
AU - Labarca, Eduardo
AU - Martinez, Felipe
AU - Carreño, Nicolás
AU - Lora, Pilar
AU - Liu, Haitao
AU - Liu, Ling
AU - Tang, Rui
AU - Luo, Xiaoming
AU - Zhao, Huiying
AU - Gao, Yan
AU - Zhai, Zhe
AU - Ye, Zheng
AU - Wang, Wei
AU - Li, Wenwen
AU - Li, Qingdong
AU - Zheng, Ruiqiang
AU - Yu, W.
AU - Shen, J.
AU - Li, Xinyu
AU - Yu, T.
AU - Lu, Weihua
AU - He, Z.
AU - Lu, Y.
AU - Han, Hui
AU - Zhang, F.
AU - Sun, R.
AU - Wang, Hua
AU - Qin, Shu
AU - Zhu, Bao
AU - Zhao, Jun
AU - Liu, Jian
AU - Li, Bin
AU - Zhou, Fa
AU - Zhang, Xing
AU - Li-Xin, Z.
AU - Xin-Hua, Q.
AU - Jiang, L.
AU - Zhao, Xian
AU - Li, Y.
AU - Wang, C.
AU - Yao, Q.
AU - Yu, Rongguo
AU - Chen, Kai
AU - Shao, H.
AU - Qin, B.
AU - Huang, Qing
AU - Zhu, Wei
AU - Hang, Ai
AU - Hua, Ma
AU - Xu, Yonghao
AU - Di, Yu
AU - Ling, Long
AU - Qin, Tie
AU - Wang, S.
AU - Qin, J.
AU - Han, Yi
AU - Zhou, Suming
AU - Vargas, Monica
AU - Rojas, Manuel
AU - Solis-Quesada, J.
AU - Ramirez-Alfaro, C.
AU - Máca, J.
AU - Sklienka, P.
AU - Gjedsted, J.
AU - Christiansen, Aage
AU - Villamagua, Boris
AU - Llano, M.
AU - Burtin, P.
AU - Buzancais, G.
AU - Beuret, P.
AU - Pelletier, Nicolas
AU - Mortaza, S.
AU - Mercat, A.
AU - Chelly, Jonathan
AU - Jochmans, S.
AU - Terzi, N.
AU - Daubin, C.
AU - Carteaux, G.
AU - de Prost, N.
AU - Chiche, J. D.
AU - Daviaud, F.
AU - Fartoukh, M.
AU - Barberet, G.
AU - Biehler, J.
AU - An, Youzhong
AU - Wu, Ya
AU - Huang, Xiao
AU - Liu, Jing
AU - Li, Qiong
AU - Gao, Yuan
AU - Li, Xiao
AU - Li, Yimin
PY - 2017/8
Y1 - 2017/8
N2 - 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.
AB - 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.
KW - Acute respiratory distress syndrome (ARDS)
KW - LUNG SAFE
KW - Geo-economic variations
KW - Patients
KW - Epidemiology
UR - http://www.scopus.com/inward/record.url?scp=85020769329&partnerID=8YFLogxK
U2 - 10.1016/S2213-2600(17)30213-8
DO - 10.1016/S2213-2600(17)30213-8
M3 - Article
C2 - 28624388
AN - SCOPUS:85020769329
SN - 2213-2600
VL - 5
SP - 627
EP - 638
JO - The Lancet Respiratory Medicine
JF - The Lancet Respiratory Medicine
IS - 8
ER -