TY - JOUR
T1 - Epidemiological characteristics, ventilator management, and clinical outcome in patients receiving invasive ventilation in intensive care units from 10 Asian middle-income countries (PRoVENT-iMiC)
T2 - An international, multicenter, prospective study
AU - Pisani, Luigi
AU - Algera, Anna Geke
AU - Neto, Ary Serpa
AU - Ahsan, Areef
AU - Beane, Abigail
AU - Chittawatanarat, Kaweesak
AU - Faiz, Abul
AU - Haniffa, Rashan
AU - Hashemian, Seyed Mohammad Reza
AU - Hashmi, Madiha
AU - Imad, Hisham Ahmed
AU - Indraratna, Kanishka
AU - Iyer, Shivakumar
AU - Kayastha, Gyan
AU - Krishna, Bhuvana
AU - Ling, Tai Li
AU - Moosa, Hassan
AU - Nadjm, Behzad
AU - Pattnaik, Rajyabardhan
AU - Sampath, Sriram
AU - Thwaites, Louise
AU - Tun, Ni Ni
AU - Yunos, Norazim Mohd
AU - Grasso, Salvatore
AU - Paulus, Frederique
AU - de Abreu, Marcelo Gama
AU - Pelosi, Paolo
AU - Day, Nick
AU - White, Nicholas J.
AU - Dondorp, Arjen M.
AU - Schultz, Marcus J.
AU - for the PRoVENT–iMIC investigators, MORU and the PROVE network
PY - 2021/3
Y1 - 2021/3
N2 - Epidemiology, ventilator management, and outcome in patients receiving invasive ventilation in intensive care units (ICUs) in middle-income countries are largely unknown. PRactice of VENTilation in Middle-income Countries is an international multicenter 4-week observational study of invasively ventilated adult patients in 54 ICUs from 10 Asian countries conducted in 2017/18. Study outcomes included major ventilator settings (including tidal volume [VT] and positive end-expiratory pressure [PEEP]); the proportion of patients at risk for acute respiratory distress syndrome (ARDS), according to the lung injury prediction score (LIPS), or with ARDS; the incidence of pulmonary complications; and ICU mortality. In 1,315 patients included, median VT was similar in patients with LIPS < 4 and patients with LIPS 3 4, but lower in patients with ARDS (7.90 [6.8–8.9], 8.0 [6.8–9.2], and 7.0 [5.8–8.4] mL/kg Predicted body weight; P = 0.0001). Median PEEP was similar in patients with LIPS < 4 and LIPS 3 4, but higher in patients with ARDS (five [5–7], five [5–8], and 10 [5–12] cmH2O; P < 0.0001). The proportions of patients with LIPS 3 4 or with ARDS were 68% (95% CI: 66–71) and 7% (95% CI: 6–8), respectively. Pulmonary complications increased stepwise from patients with LIPS < 4 to patients with LIPS 3 4 and patients with ARDS (19%, 21%, and 38% respectively; P = 0.0002), with a similar trend in ICU mortality (17%, 34%, and 45% respectively; P < 0.0001). The capacity of the LIPS to predict development of ARDS was poor (receiver operating characteristic [ROC] area under the curve [AUC] of 0.62, 95% CI: 0.54–0.70). In Asian middle-income countries, where two-thirds of ventilated patients are at risk for ARDS according to the LIPS and pulmonary complications are frequent, setting of VT is globally in line with current recommendations.
AB - Epidemiology, ventilator management, and outcome in patients receiving invasive ventilation in intensive care units (ICUs) in middle-income countries are largely unknown. PRactice of VENTilation in Middle-income Countries is an international multicenter 4-week observational study of invasively ventilated adult patients in 54 ICUs from 10 Asian countries conducted in 2017/18. Study outcomes included major ventilator settings (including tidal volume [VT] and positive end-expiratory pressure [PEEP]); the proportion of patients at risk for acute respiratory distress syndrome (ARDS), according to the lung injury prediction score (LIPS), or with ARDS; the incidence of pulmonary complications; and ICU mortality. In 1,315 patients included, median VT was similar in patients with LIPS < 4 and patients with LIPS 3 4, but lower in patients with ARDS (7.90 [6.8–8.9], 8.0 [6.8–9.2], and 7.0 [5.8–8.4] mL/kg Predicted body weight; P = 0.0001). Median PEEP was similar in patients with LIPS < 4 and LIPS 3 4, but higher in patients with ARDS (five [5–7], five [5–8], and 10 [5–12] cmH2O; P < 0.0001). The proportions of patients with LIPS 3 4 or with ARDS were 68% (95% CI: 66–71) and 7% (95% CI: 6–8), respectively. Pulmonary complications increased stepwise from patients with LIPS < 4 to patients with LIPS 3 4 and patients with ARDS (19%, 21%, and 38% respectively; P = 0.0002), with a similar trend in ICU mortality (17%, 34%, and 45% respectively; P < 0.0001). The capacity of the LIPS to predict development of ARDS was poor (receiver operating characteristic [ROC] area under the curve [AUC] of 0.62, 95% CI: 0.54–0.70). In Asian middle-income countries, where two-thirds of ventilated patients are at risk for ARDS according to the LIPS and pulmonary complications are frequent, setting of VT is globally in line with current recommendations.
UR - http://www.scopus.com/inward/record.url?scp=85103166193&partnerID=8YFLogxK
U2 - 10.4269/ajtmh.20-1177
DO - 10.4269/ajtmh.20-1177
M3 - Article
C2 - 33432906
AN - SCOPUS:85103166193
VL - 104
SP - 1022
EP - 1033
JO - The American Journal of Tropical Medicine and Hygiene
JF - The American Journal of Tropical Medicine and Hygiene
SN - 0002-9637
IS - 3
ER -