@article{2a47d1a893d64d4e82791e3872878137,
title = "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",
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.",
keywords = "Aged, Comorbidity, Delivery of Health Care, Developed Countries, Developing Countries, Europe, Female, Geography, Medical, Humans, Income, Intensive Care Units, Male, Middle Aged, Patient Outcome Assessment, Prospective Studies, Respiratory Distress Syndrome, Adult, Risk Factors",
author = "\{LUNG SAFE Investigators\} and \{ESICM Trials Group\} and 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 and L. Gattinoni and A. Larsson and Thompson, \{B. T.\} and F. Rios and T. Sottiaux and P. Depuydt and Lora, \{F. S.\} and Azevedo, \{L. C.\} and G. Bugedo and M. Gonzalez and J. Silesky and J. Nielsen and M. Jibaja and D. Matamis and Ranero, \{J. L.\} and Hashemian, \{S. M.\} and A. Villagomez and Zeggwagh, \{A. A.\} and Fernandes, \{A. D.V.\} and D. Sandesc and V. Bumbasierevic and F. Abroug and J. Hurtado and G. D{\'e}mpaire and H. Sula and L. Nunci and A. Cani and A. Zazu and C. Dellera and Alejandro, \{R. V.\} and J. Daldin and Fernandez, \{R. O.\} and Cardonnet, \{L. P.\} and Bettini, \{L. R.\} and Bisso, \{M. C.\} and Osman, \{E. M.\} and Setten, \{M. G.\} and P. Lovazzano and J. Alvarez and V. Villar and Pozo, \{N. C.\} and N. Grubissich and Plotnikow, \{G. A.\} and Vasquez, \{D. N.\} and S. Ilutovich and N. Tiribelli and A. Chena and Pellegrini, \{C. A.\} and Saenz, \{M. G.\} and E. Estenssoro and M. Brizuela and H. Gianinetto and Gomez, \{P. E.\} and Cerrato, \{V. I.\} and Bezzi, \{M. G.\} and Borello, \{S. A.\} and Loiacono, \{F. A.\} and Fernandez, \{A. M.\} and S. Knowles and C. Reynolds and Inskip, \{D. M.\} and Miller, \{J. J.\} and J. Kong and C. Whitehead and S. Bihari and A. Seven and A. Krstevski and H. Rodgers and R. Millar and T. Mckenna and I. Bailey and G. Hanlon and A. Aneman and J. Lynch and R. Azad and J. Neal and P. Woods and B. Roberts and M. Kol and H. Wong and K. Riss and T. Staudinger and X. Wittebole and C. Berghe and P. Bulpa and A. Dive and R. Verstraete and H. Lebbinck and J. Vermassen and P. Meersseman and H. Ceunen and J. Rosa and D. Beraldo and C. Piras and A. Rampinelli and A. Nassar and S. Mataloun and M. Moock and M. Thompson and C. Gon{\c c}alves and A. Ant{\^o}nio and A. Ascoli and R. Biondi and D. Fontenele and D. Nobrega and V. Sales and S. Shindhe and D. Ismail and F. Beloncle and K. Davies and R. Cirone and V. Manoharan and M. Ismail and E. Goligher and M. Jassal and E. Nishikawa and A. Javeed and G. Curley and N. Rittayamai and M. Parotto and N. Ferguson and S. Mehta and J. Knoll and A. Pronovost and S. Canestrini and P. Garcia and F. Aliaga and P. Far{\'i}as and J. Yumha and C. Ortiz and J. Salas and A. Saez and L. Vega and E. Labarca and F. Martinez and N. Carre{\~n}o and P. Lora and H. Liu and L. Liu and R. Tang and X. Luo and Y. Di and H. Zhao and Y. Gao and Z. Zhai and Z. Ye and W. Wang and W. Li and Q. Li and R. Zheng and W. Yu and J. Shen and X. Li and T. Yu and W. Lu and Y. Wu and X. Huang and Z. He and Y. Lu and H. Han and F. Zhang and R. Sun and H. Wang and S. Qin and B. Zhu and J. Zhao and J. Liu and B. Li and F. Zhou and X. Zhang and Z. Li-Xin and Q. Xin-Hua and L. Jiang and X. Zhao and Y. Li and C. Wang and Q. Yao and R. Yu and K. Chen and H. Shao and B. Qin and Q. Huang and W. Zhu and A. Hang and M. Hua and Y. Xu and Y. Di and L. Ling and T. Qin and S. Wang and J. Qin and Y. Han and S. Zhou and M. Vargas and M. Rojas and J. Solis-Quesada and C. Ramirez-Alfaro and J. M{\'a}ca and P. Sklienka and J. Gjedsted and A. Christiansen and B. Villamagua and M. Llano and P. Burtin and G. Buzancais and P. Beuret and N. Pelletier and S. Mortaza and A. Mercat and J. Chelly and S. Jochmans and N. Terzi and C. Daubin and G. Carteaux and \{de Prost\}, N. and Chiche, \{J. D.\} and F. Daviaud and M. Fartoukh and G. Barberet and J. Biehler and J. Dellamonica and D. Doyen and Arnal, \{J. M.\} and A. Briquet and S. Hraiech and L. Papazian and D. Roux and J. Messika and E. Kalaitzis and L. Dangers and A. Combes and Au, \{S. M.\} and G. B{\'e}duneau and D. Carpentier and E. Zogheib and H. Dupont and S. Ricome and F. Santoli and S. Besset and P. Michel and B. Gel{\'e}e and Danin, \{P. E.\} and B. Goubaux and P. Crova and N. Phan and F. Berkelmans and J. Badie and R. Tapponnier and J. Gally and S. Khebbeb and Herbrecht, \{J. E.\} and F. Schneider and Declercq, \{P. L.\} and Rigaud, \{J. P.\} and J. Duranteau and A. Harrois and R. Chabanne and J. Marin and C. Bigot and S. Thibault and M. Ghazi and M. Boukhazna and S. Zein and J. Richecoeur and D. Combaux and F. Grelon and \{Le Moal\}, C. and E. Sauvadet and A. Robine and V. Lemiale and D. Reuter and M. Dres and A. Demoule and D. Goldgran-Toledano and L. Baboi and C. Gu{\'e}rin and R. Lohner and J. Kra{\ss}ler and S. Sch{\"a}fer and K. Zacharowski and P. Meybohm and A. Reske and P. Simon and Hopf, \{H. B.\} and M. Schuetz and T. Baltus and M. Papanikolaou and T. Papavasilopoulou and G. Zacharas and V. Ourailogloy and E. Mouloudi and E. Massa and E. Nagy and E. Stamou and E. Kiourtzieva and M. Oikonomou and L. Avila and C. Cortez and J. Cital{\'a}n and S. Jog and S. Sable and B. Shah and M. Gurjar and A. Baronia and M. Memon and R. Muthuchellappan and V. Ramesh and A. Shenoy and R. Unnikrishnan and S. Dixit and R. Rhayakar and N. Ramakrishnan and V. Bhardwaj and H. Mahto and S. Sagar and V. Palaniswamy and D. Ganesan and H. Jamaati and F. Heidari and E. Meaney and A. Nichol and K. Knapman and D. O'Croinin and E. Dunne and D. Breen and R. Jaafar and R. Dwyer and F. Amir and O. Ajetunmobi and A. O'Muircheartaigh and C. Black and N. Treanor and D. Collins and W. Altaf and G. Zani and M. Fusari and S. Spadaro and C. Volta and R. Graziani and B. Brunettini and S. Palmese and P. Formenti and M. Umbrello and A. Lombardo and E. Pecci and M. Botteri and M. Savioli and A. Protti and A. Mattei and L. Schiavoni and A. Tinnirello and M. Todeschini and A. Giarratano and A. Cortegiani and S. Sher and A. Rossi and M. Antonelli and L. Montini and P. Casalena and S. Scafetti and G. Panarello and G. Occhipinti and N. Patroniti and M. Pozzi and R. Biscione and M. Poli and F. Raimondi and D. Albiero and G. Crapelli and E. Beck and V. Pota and V. Schiavone and A. Molin and F. Tarantino and G. Monti and E. Frati and L. Mirabella and G. Cinnella and T. Fossali and R. Colombo and P. Terragni and I. Pattarino and F. Mojoli and A. Braschi and E. Borotto and A. Cracchiolo and D. Palma and F. Raponi and G. Foti and E. Vascotto and A. Coppadoro and L. Brazzi and L. Floris and G. Iotti and A. Venti and O. Yamaguchi and S. Takagi and H. Maeyama and E. Watanabe and Y. Yamaji and K. Shimizu and K. Shiozaki and S. Futami and S. Ryosuke and K. Saito and Y. Kameyama and K. Ueno and M. Izawa and N. Okuda and H. Suzuki and T. Harasawa and M. Nasu and T. Takada and F. Ito and S. Nunomiya and K. Koyama and T. Abe and K. Andoh and K. Kusumoto and A. Hirata and A. Takaba and H. Kimura and S. Matsumoto and U. Higashijima and H. Honda and N. Aoki and H. Imai and Y. Ogino and I. Mizuguchi and K. Ichikado and K. Nitta and K. Mochizuki and T. Hashida and H. Tanaka and T. Nakamura and D. Niimi and T. Ueda and Y. Kashiwa and A. Uchiyama and Oļegs Sabelnikovs and Pēteris O{\v s}s and Y. Haddad and K. Liew and S. {\~N}amendys-Silva and Y. Jarquin-Badiola and L. Sanchez-Hurtado and S. Gomez-Flores and M. Marin and J. Lemus and J. Fierro and M. Cervantes and F. Mejia and Dector, \{D. M.\} and D. Gonzalez and C. Estrella and J. Sanchez-Medina and A. Ramirez-Gutierrez and F. George and J. Aguirre and J. Buensuseso and M. Poblano and T. Dendane and H. Balkhi and M. Elkhayari and N. Samkaoui and H. Ezzouine and A. Benslama and M. Amor and W. Maazouzi and N. Cimic",
note = "Publisher Copyright: {\textcopyright} 2017 Elsevier Ltd",
year = "2017",
month = aug,
day = "1",
doi = "10.1016/S2213-2600(17)30213-8",
language = "English",
volume = "5",
pages = "627--638",
journal = "The Lancet Respiratory Medicine",
issn = "2213-2600",
publisher = "Elsevier Ltd.",
number = "8",
}