Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. MethodsIn this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middleincome countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42•4% vs 44•2%; absolute difference -1•69 [-9•58 to 6•11] p=0•67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H 2 O; p=0•0011). ICU mortality was higher in MICs than in HICs (30•5% vs 19•9%; p=0•0004; adjusted effect 16•41% [95% CI 9•52-23•52]; p<0•0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0•80 [95% CI 0•75-0•86]; p<0•0001).Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status.

Background: Bifurcation lesions remain a challenge and little is known about the characteristics and outcomes of percutaneous coronary intervention over the last decade with the increasing use of drug-eluting stents. The objective of this study was to identify the patient profile and the in-hospital outcomes as well as the predictors of in-hospital death over time. Methods: An observational, retrospective study that evaluated patients undergoing percutaneous coronary intervention for bifurcation lesions between 2006 and 2016. Patients were divided into three groups: 2006-2008 (Group 1), 2009-2011 (Group 2), and 2012-2016 (Group 3). We used multiple logistic regression analysis to identify independent predictors of in-hospital death. Results: A total of 36,608 patients were included, and Group 3 patients were older, with a higher number of comorbidities, more stable clinical presentation and lesions treated with longer stent length and smaller stent size. The success of the procedure was higher (96.1% vs. 97.4% vs. 98.1%; p<0.0001) and the mortality lower (1.2% vs. 0.7% vs. 0.6%; p<0.0001) in the most recently treated group. In the multiple logistic regression analysis, female sex, left main coronary artery lesions, primary percutaneous coronary intervention, rescue percutaneous coronary intervention, procedures performed between 2006-2008 and use of glycoprotein IIb/IIIa inhibitors were variables independently associated with in-hospital mortality. Conclusions: Female sex, acute clinical presentation, emergency percutaneous coronary intervention, and greater anatomical complexity were associated with in-hospital mortality in patients undergoing coronary bifurcation treatment. Advances in contemporary treatment possibly contributed to the clinical outcome improvement in these patients.