PT  - JOURNAL ARTICLE
AU  - Anna Geke Algera
AU  - Luigi Pisani
AU  - Frederique Paulus
AU  - Ary Serpa Neto
AU  - Marcus Schultz
TI  - Variation in ventilation management and outcome in ICU patients without ARDS – an IPD metaanalysis of 4 worldwide observational studies
AID  - 10.1183/13993003.congress-2020.3727
DP  - 2020 Sep 07
TA  - European Respiratory Journal
PG  - 3727
VI  - 56
IP  - suppl 64
4099  - http://erj.ersjournals.com/content/56/suppl_64/3727.short
4100  - http://erj.ersjournals.com/content/56/suppl_64/3727.full
SO  - Eur Respir J2020 Sep 07; 56
AB  - Background: It is uncertain whether geo–economic variation exists in ventilation and outcome in ventilated ICU patients without ARDS.Methods: Individual patient data from 4 studies in 350 ICUs in 54 countries were merged. 2016 World Bank classification was used to create groups, i.e., high–income (HICs) and low– and middle–income countries (LMICs). Endpoints were use of low VT ventilation (LTVV, VT ≤ 8 ml/kg PBW in first 3 days) and median VT (co–primary), PEEP and ΔP, and ICU mortality. Variable adjusted life display was used to assess cumulative excess mortality according to country classification.Results: The analysis included 1,507 and 2,408 patients from HIC and LMIC. Use of LTVV (44 vs 43%; P=NS) and median VT (7.6 [6.6–9.0] vs 7.9 [6.8–9.0] ml/kg PBW; P=NS) (Fig. panel A), median PEEP and ΔP (Fig. panel B–C), and median SOFA scores (7 [5–10] vs 7 [5–10]; P=NS) were all not different between HIC and LMIC. Crude ICU mortality in LMIC was higher (20 vs 30%; p<0.001) and observed mortality was higher than expected mortality (based on SOFA) in LMICs in patients >30 years (Fig. panel D). Conclusions: There is little geo–economic variation in ventilation management in ICU patients without ARDS. The remarkable differences in ICU mortality between HIC and LMICs cannot be explained by differences in ventilation, and also not by disease severity.FootnotesCite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 3727.This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).