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

John G. Laffey, Fabiana Madotto, Giacomo Bellani, Tài Pham, Eddy Fan, Laurent Brochard, Pravin Amin, Yaseen Arabi, Ednan K. Bajwa, Alejandro Bruhn, Vladimir Cerny, Kevin Clarkson, Leo Heunks, Kiyoyasu Kurahashi, Jon Henrik Laake, Jose A. Lorente, Lia McNamee, Nicolas Nin, Jose Emmanuel Palo, Lise Piquilloud & 10 others Haibo Qiu, Juan Ignacio Silesky Jiménez, Andres Esteban, Daniel F. McAuley, Frank van Haren, Marco Ranieri, Gordon Rubenfeld, Hermann Wrigge, Arthur S. Slutsky, Antonio Pesenti

Research output: Contribution to journalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)627-638
Number of pages12
JournalThe Lancet Respiratory Medicine
Volume5
Issue number8
DOIs
Publication statusPublished - 1 Aug 2017

Cite this

Laffey, John G. ; Madotto, Fabiana ; Bellani, Giacomo ; Pham, Tài ; Fan, Eddy ; Brochard, Laurent ; Amin, Pravin ; Arabi, Yaseen ; Bajwa, Ednan K. ; Bruhn, Alejandro ; Cerny, Vladimir ; Clarkson, Kevin ; Heunks, Leo ; Kurahashi, Kiyoyasu ; Laake, Jon Henrik ; Lorente, Jose A. ; McNamee, Lia ; Nin, Nicolas ; Palo, Jose Emmanuel ; Piquilloud, Lise ; Qiu, Haibo ; Jiménez, Juan Ignacio Silesky ; Esteban, Andres ; McAuley, Daniel F. ; van Haren, Frank ; Ranieri, Marco ; Rubenfeld, Gordon ; Wrigge, Hermann ; Slutsky, Arthur S. ; Pesenti, Antonio. / 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. In: The Lancet Respiratory Medicine. 2017 ; Vol. 5, No. 8. pp. 627-638.
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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.",
author = "Laffey, {John G.} and Fabiana Madotto and Giacomo Bellani and T{\`a}i Pham and Eddy Fan and Laurent Brochard and Pravin Amin and Yaseen Arabi and Bajwa, {Ednan K.} and Alejandro Bruhn and Vladimir Cerny and Kevin Clarkson and Leo Heunks and Kiyoyasu Kurahashi and Laake, {Jon Henrik} and Lorente, {Jose A.} and Lia McNamee and Nicolas Nin and Palo, {Jose Emmanuel} and Lise Piquilloud and Haibo Qiu and Jim{\'e}nez, {Juan Ignacio Silesky} and Andres Esteban and McAuley, {Daniel F.} and {van Haren}, Frank and Marco Ranieri and Gordon Rubenfeld and Hermann Wrigge and Slutsky, {Arthur S.} and Antonio Pesenti",
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Laffey, JG, Madotto, F, Bellani, G, Pham, T, Fan, E, Brochard, L, Amin, P, Arabi, Y, Bajwa, EK, Bruhn, A, Cerny, V, Clarkson, K, Heunks, L, Kurahashi, K, Laake, JH, Lorente, JA, McNamee, L, Nin, N, Palo, JE, Piquilloud, L, Qiu, H, Jiménez, JIS, Esteban, A, McAuley, DF, van Haren, F, Ranieri, M, Rubenfeld, G, Wrigge, H, Slutsky, AS & Pesenti, A 2017, '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' The Lancet Respiratory Medicine, vol. 5, no. 8, pp. 627-638. https://doi.org/10.1016/S2213-2600(17)30213-8

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

In: The Lancet Respiratory Medicine, Vol. 5, No. 8, 01.08.2017, p. 627-638.

Research output: Contribution to journalArticleAcademicpeer-review

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

PY - 2017/8/1

Y1 - 2017/8/1

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.

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

VL - 5

SP - 627

EP - 638

JO - Lancet respiratory medicine

JF - Lancet respiratory medicine

SN - 2213-2600

IS - 8

ER -