Variation in ventilation management and outcome in ICU patients without ARDS – an IPD metaanalysis of 4 worldwide observational studies

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 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.