Epidemiological Characteristics, Ventilator Management, and Clinical Outcome in Patients Receiving Invasive Ventilation in Intensive Care Units from 10 Asian Middle-Income Countries (PRoVENT-iMiC): An International, Multicenter, Prospective Study

Pisani, Luigi; Algera, Anna Geke; Neto, Ary Serpa; Ahsan, Areef; Beane, Abi; Chittawatanarat, Kaweesak; Faiz, Abul; Hashemian, Seyed Mohammadreza; Imad, Hisham Ahmed; Indraratna, Kanishka; Iyer, Shivakumar; Kayastha, Gyan; Krishna, Bhuvana; Ling, Tai Li; Moosa, Hassan; Nadjm, Behzad; Pattnaik, Rajyabardhan; Subramaniam, Sriram; Thwaites, Louise; Tun, Ni Ni; Yunos, Nor’azim Mohd; Grasso, Salvatore; Paulus, Frederique; Abreu, Marcelo Gama de; Pelosi, Paolo; Day, Nick; White, Nicholas J.; Dondorp, Arjen M.; Schultz, Marcus J.

doi:10.4269/ajtmh.20-1177

Cited by 22 publications

(29 citation statements)

References 32 publications

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“… 9 , 12 , 16 , 17 A similar use of protective mechanical ventilation has been reported from Asian middle-income countries. 24 In accordance with existing information for ARDS not related to COVID-19, 25 driving pressure was strongly associated with mortality, which is a novel finding.…”

Section: Discussionsupporting

confidence: 81%

Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): a prospective, multicentre cohort study

Bakker

Dubin

Loudet

et al. 2021

The Lancet Respiratory Medicine

104

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Background Although COVID-19 has greatly affected many low-income and middle-income countries, detailed information about patients admitted to the intensive care unit (ICU) is still scarce. Our aim was to examine ventilation characteristics and outcomes in invasively ventilated patients with COVID-19 in Argentina, an upper middle-income country. Methods In this prospective, multicentre cohort study (SATICOVID), we enrolled patients aged 18 years or older with RT-PCR-confirmed COVID-19 who were on invasive mechanical ventilation and admitted to one of 63 ICUs in Argentina. Patient demographics and clinical, laboratory, and general management variables were collected on day 1 (ICU admission); physiological respiratory and ventilation variables were collected on days 1, 3, and 7. The primary outcome was all-cause in-hospital mortality. All patients were followed until death in hospital or hospital discharge, whichever occurred first. Secondary outcomes were ICU mortality, identification of independent predictors of mortality, duration of invasive mechanical ventilation, and patterns of change in physiological respiratory and mechanical ventilation variables. The study is registered with ClinicalTrials.gov , NCT04611269 , and is complete. Findings Between March 20, 2020, and Oct 31, 2020, we enrolled 1909 invasively ventilated patients with COVID-19, with a median age of 62 years [IQR 52–70]. 1294 (67·8%) were men, hypertension and obesity were the main comorbidities, and 939 (49·2%) patients required vasopressors. Lung-protective ventilation was widely used and median duration of ventilation was 13 days (IQR 7–22). Median tidal volume was 6·1 mL/kg predicted bodyweight (IQR 6·0–7·0) on day 1, and the value increased significantly up to day 7; positive end-expiratory pressure was 10 cm H 2 O (8–12) on day 1, with a slight but significant decrease to day 7. Ratio of partial pressure of arterial oxygen (PaO 2 ) to fractional inspired oxygen (FiO 2 ) was 160 (IQR 111–218), respiratory system compliance 36 mL/cm H 2 O (29–44), driving pressure 12 cm H 2 O (10–14), and FiO 2 0·60 (0·45–0·80) on day 1. Acute respiratory distress syndrome developed in 1672 (87·6%) of patients; 1176 (61·6%) received prone positioning. In-hospital mortality was 57·7% (1101/1909 patients) and ICU mortality was 57·0% (1088/1909 patients); 462 (43·8%) patients died of refractory hypoxaemia, frequently overlapping with septic shock (n=174). Cox regression identified age (hazard ratio 1·02 [95% CI 1·01–1·03]), Charlson score (1·16 [1·11–1·23]), endotracheal intubation outside of the ICU (ie, before ICU admission; 1·37 [1·10–1·71]), vasopressor use on day 1 (1·29 [1·07–1·55]), D-dimer concentration (1·02 [1·01–1·03]), PaO 2 /FiO ...

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Section: Discussionsupporting

confidence: 81%

Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): a prospective, multicentre cohort study

Bakker

Dubin

Loudet

et al. 2021

The Lancet Respiratory Medicine

104

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“…The lung injury prediction score performs poorly in predicting ARDS, as also suggested by one validation study 24 and subsequent investigations. 16,21,35 However, we cannot exclude the possibility that ARDS was underdiagnosed in ICUs in MICs. Although, physicians in MICs seem to recognise ARDS equally well or even better than those in HICs, 9,36 some ICUs might not have the resources to apply the Berlin definition for ARDS such as chest x-ray imaging and blood gas analysis.…”

Section: Table 3: Clinical Outcomes According To the Economic Groupmentioning

confidence: 96%

“…4 In the PRoVENT-iMIC study performed in Asia, which reported availability of diagnostic tools, x-ray apparatuses and blood gas analysers were available for over 90% of centres, although the resources were often shared with the hospital and not dedicated to the ICU. 21 LUNG SAFE was the only study to use an additional algorithm-based tool to identify patients who fulfilled the Berlin definition of ARDS. 13 Although notable differences were found in demographics and comorbidities, there was neither a difference in diseases severity on ICU admission, nor in the practice of ventilation, between HICs and MICs.…”

Section: Table 3: Clinical Outcomes According To the Economic Groupmentioning

confidence: 99%

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Pisani

Algera

Neto

et al. 2022

The Lancet Global Health

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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.

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“…However, measuring the PaO 2 is not always possible or could be too costly to use in resource–limited settings. While in some middle–income countries arterial blood gas measurements are increasingly available, [ 5 ] access is far from universal in critical care facilities worldwide [ 6 , 7 ]. In a recent report on COVID-19 in African ICUs, in only 82% of the participating hospitals there was a possibility to perform blood gas analyses [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostication using SpO2/FiO2 in invasively ventilated ICU patients with ARDS due to COVID-19 – Insights from the PRoVENT-COVID study

Mazzinari

Neto

Hollmann

et al. 2022

Journal of Critical Care

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Background The SpO 2 /FiO 2 is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO 2 /FiO 2 for mortality in patients with ARDS due to COVID–19. Methods This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID–19. The primary endpoint was 28–day mortality. Results In 869 invasively ventilated patients, 28–day mortality was 30.1%. The SpO 2 /FiO 2 on day 1 had no prognostic value. The SpO 2 /FiO 2 on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO 2 /FiO 2 on day 2 (OR, 0.66 [95%–CI 0.46–0.96]) and on day 3 (OR, 0.70 [95%–CI 0.51–0.96]) were associated with 28–day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76–0.79]). The measured PaO 2 /FiO 2 and the PaO 2 /FiO 2 calculated from SpO 2 /FiO 2 were strongly correlated (Spearman's r = 0.79). Conclusions In this cohort of patients with ARDS due to COVID–19, the SpO 2 /FiO 2 on day 2 and day 3 are independently associated with and have prognostic capacity for 28–day mortality. The SpO 2 /FiO 2 is a useful metric for risk stratification in invasively ventilated COVID–19 patients.

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Epidemiological Characteristics, Ventilator Management, and Clinical Outcome in Patients Receiving Invasive Ventilation in Intensive Care Units from 10 Asian Middle-Income Countries (PRoVENT-iMiC): An International, Multicenter, Prospective Study

Cited by 22 publications

References 32 publications

Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): a prospective, multicentre cohort study

Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): a prospective, multicentre cohort study

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Prognostication using SpO2/FiO2 in invasively ventilated ICU patients with ARDS due to COVID-19 – Insights from the PRoVENT-COVID study

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