Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada; Department of Critical Care Medicine, St Michael's Hospital, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesia, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Research Center on Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Lancet Respir Med. 2017 Aug;5(8):627-638. doi: 10.1016/S2213-2600(17)30213-8. Epub 2017 Jun 15.
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).
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.
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 (PaO) to the fractional concentration of oxygen in inspired air (FO) 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.
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.
European Society of Intensive Care Medicine, St Michael's Hospital, University of Milan-Bicocca.
关于急性呼吸窘迫综合征（ARDS）患者的人口统计学、管理和结局的地域经济差异，相关信息较少。我们旨在通过在六大洲 50 个国家的 459 个重症监护病房进行的大型观察性研究来了解严重急性呼吸衰竭的全球影响（LUNG SAFE），来描述这些地域经济差异的影响。
LUNG SAFE 于 2014 年冬季的连续四周内进行，在来自六大洲 50 个国家的 459 个重症监护病房进行了便利抽样。纳入标准为在入组窗口内入住参与的重症监护病房（包括转院）并接受有创或无创通气。该试验的次要目标之一是描述 ARDS 患者的人口统计学、管理和结局的差异。我们使用 2016 年世界银行国家分类法将三个主要的地域经济分组定义为：欧洲高收入国家（欧洲高收入组）、世界其他地区的高收入国家（其他高收入地区）和中等收入国家（中等收入组）。我们比较了这三个组之间的患者结局。LUNG SAFE 在 ClinicalTrials.gov 上注册，编号为 NCT02010073。
在符合 ARDS 标准的 2813 名 LUNG SAFE 患者中，有 1521 名（54%）来自欧洲高收入组，746 名（27%）来自其他高收入地区，546 名（19%）来自中等收入国家。我们注意到在人口统计学、ARDS 危险因素和合并症方面存在明显的地域差异。与其他两个地区相比，其他高收入地区严重 ARDS 或动脉血氧分压（PaO）与吸入空气的氧分数比（FO）比值小于 150 的患者比例明显较低。在欧洲高收入地区，俯卧位和神经肌肉阻滞的使用率明显高于其他两个地区。其他高收入地区患者的有创机械通气时间和重症监护病房住院时间明显短于欧洲高收入或中等收入地区。人均国民总收入较高与 ARDS 存活率增加相关；与欧洲高收入或其他高收入地区相比，中等收入国家的医院存活率明显较低。
ARDS 的严重程度、临床医生的认识和管理以及患者的结局存在重要的地域经济差异。人均收入和 ARDS 结局独立相关。
欧洲重症监护医学学会、圣迈克尔医院、米兰比可卡大学。
