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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
JG. Laffey, F. Madotto, G. Bellani, T. Pham, E. Fan, L. Brochard, P. Amin, Y. Arabi, EK. Bajwa, A. Bruhn, V. Cerny, K. Clarkson, L. Heunks, K. Kurahashi, JH. Laake, JA. Lorente, L. McNamee, N. Nin, JE. Palo, L. Piquilloud, H. Qiu, JIS. Jiménez,...
Language English Country England, Great Britain
Document type Journal Article, Observational Study, Research Support, Non-U.S. Gov't
- MeSH
- Patient Outcome Assessment MeSH
- Intensive Care Units statistics & numerical data MeSH
- Comorbidity MeSH
- Geography, Medical MeSH
- Middle Aged MeSH
- Humans MeSH
- Delivery of Health Care statistics & numerical data MeSH
- Income statistics & numerical data MeSH
- Prospective Studies MeSH
- Risk Factors MeSH
- Developing Countries statistics & numerical data MeSH
- Aged MeSH
- Respiratory Distress Syndrome economics epidemiology MeSH
- Developed Countries statistics & numerical data MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe epidemiology MeSH
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.
Adult Intensive Care and Burn Unit University Hospital of Lausanne Lausanne Switzerland
Australian National University Canberra ACT Australia
Centre for Experimental Medicine Queen's University of Belfast Belfast Northern Ireland UK
Department of Anesthesia St Michael's Hospital Toronto ON Canada
Department of Anesthesia University of Toronto Toronto ON Canada
Department of Anesthesiology and Intensive Care Medicine University of Leipzig Leipzig Germany
Department of Critical Care Medicine Bombay Hospital Institute of Medical Sciences Mumbai India
Department of Critical Care Medicine St Michael's Hospital Toronto ON Canada
Department of Emergency and Intensive Care San Gerardo Hospital Monza Italy
Department of Intensive Care VU University Medical Centre Amsterdam Netherlands
Department of Medical Intensive Care University Hospital of Angers Angers France
Department of Medicine University Health Network and Mount Sinai Hospital Toronto ON Canada
Department of Physiology University of Toronto Toronto ON Canada
Faculty of Medicine in Hradec Kralove Hradec Kralove Czech Republic
Hospital Español Montevideo Uruguay
Institute of Health Policy Management and Evaluation University of Toronto Toronto ON Canada
Intensive Care Department King Saud Bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia
Intensive Care Unit Canberra Hospital Canberra ACT Australia
Interdepartmental Division of Critical Care Medicine University of Toronto Toronto ON Canada
King Abdullah International Medical Research Center Riyadh Saudi Arabia
Program in Trauma Emergency and Critical Care Sunnybrook Health Sciences Center Toronto ON Canada
Section of Adult Critical Care Department of Medicine The Medical City Pasig Philippines
Sorbonne Universités UPMC Université Paris 06 Paris France
Wellcome Wolfson Institute for Experimental Medicine Belfast Northern Ireland UK
References provided by Crossref.org
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- $a Laffey, John G $u 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.
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