Fulltext

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 L 1 , Algera AG 1 , Serpa Neto A 1 , Ahsan A 2 , Beane A 3 , Chittawatanarat K 4 Show all authors , Faiz A 3 , Haniffa R 5 , Hashemian SM 6 , Hashmi M 7 , Imad HA 8 , Indraratna K 9 , Iyer S 10 , Kayastha G 11 , Krishna B 12 , Ling TL 13 , Moosa H 14 , Nadjm B 15 , Pattnaik R 16 , Sampath S 12 , Thwaites L 17 , Tun NN 18 , Mohd Yunos N 19 , Grasso S 20 , Paulus F 1 , Gama de Abreu M 21 , Pelosi P 22 , Day N 3 , White NJ 3 , Dondorp AM 3 , Schultz MJ 1 , PRoVENT-iMiC Investigators, MORU, and the PROVE Network

Affiliations 

  • 1 1Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
  • 2 4Department of Critical Care, BIRDEM General Hospital, Dhaka, Bangladesh
  • 3 2Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
  • 4 5Department of Surgery, Chiang Mai University, Chiang Mai, Thailand
  • 5 3Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
  • 6 7Chronic Respiratory Diseases Research Center (CRDRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • 7 8Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
  • 8 9Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
  • 9 10Department of Anaesthesia and Intensive Care, Sri Jayewardenepura General Hospital, Colombo, Sri Lanka
  • 10 11Department of Medicine, Bharati Vidyapeeth Medical College, Pune, India
  • 11 12Department of Internal Medicine, Patan Academy of Health Science, Kathmandu, Nepal
  • 12 13Department of Critical Care Medicine, St. John's Medical College, Bangalore, India
  • 13 14Department of Anaesthesia and Intensive Care, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  • 14 15Department of Intensive Care, Indira Gandhi Memorial Hospital, Malé, Maldives
  • 15 16National Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Hanoi, Vietnam
  • 16 17Critical Care Unit, Ispat General Hospital, Rourkela, India
  • 17 18Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
  • 18 19Medical Action Myanmar, Naypyidaw, Myanmar
  • 19 20Department of Anaesthesiology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 20 21Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
  • 21 22Pulmonary Engineering Group, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
  • 22 23San Martino Policlinico Hospital - IRCCS for Oncology, University of Genoa, Genoa, Italy
Am J Trop Med Hyg, 2021 01 11;104(3):1022-1033.
PMID: 33432906 DOI: 10.4269/ajtmh.20-1177

Abstract

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 [V T ] 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 V T was similar in patients with LIPS < 4 and patients with LIPS ≥ 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 ≥ 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 ≥ 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 ≥ 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 V T is globally in line with current recommendations.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications