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John LaffeyCritical Illness and Injury Research Centre, Keenan
Research Centre, St Michael’s Hospital.
Departments of Anesthesia, Physiology and Interdepartmental division of Critical Care
Medicine, University of Toronto,
Toronto, CANADA
Impact of Income on Outcome
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Conflict of Interest
• Tissue Regeneration Therapeutics, Toronto, Canada
• Orbsen Therapeutics Ltd, Galway, Ireland
• CommenceBio, California, USA
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Diabetes
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• Impact of severe acute respiratory failure in ICUs in ‘winter’ months– Burden of Severe Acute Respiratory Failure
– ARDS versus other causes
• LUNG SAFE Database– 450 participating ICUs in 50 countries across 5
continents
– Data from 12,906 patients
– 4,499 patients with AHRF/ARDS
LUNG SAFE
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Distribution of Participating ICUs
• 62 Countries with ICUs Registered• 50 countries recruited patients (40/10)• 38 countries recruited > 25 patients
Bellani et al JAMA 2016
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Europe – High Income Rest of World – High
Income
Middle income
Austria Australia Albania
Belgium Brunei Argentina
Czech Republic Canada Brazil
Denmark Chile China
France Japan Colombia
Germany New Zealand Costa Rica
Greece Saudi Arabia Ecuador
Ireland United States Guatemala
Italy Uruguay India
Latvia Iran
Netherlands Lebanon
Norway Malaysia
Poland Mexico
Portugal Morocco
Spain Peru
Sweden Philippines
Switzerland Romania
United Kingdom Russian Federation
Serbia
South Africa
Tunisia
Turkey
229 ICUs 110 ICUs 120 ICUs
World Bank - Gross National Income Categories
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ARDS Outcome
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• ARDS Demographics– European pts older; Greater ARDS Severity Profile
– ROW pts greater systemic illness severity (SOFA)
• Ventilator Management Approaches– Lower Tidal volumes in ROW-High Income patients
– Greater Oxygen use in European patients
• Use of Adjunctive Measures– Greater NMB use and Prone positioning use in Europe
– Recruitment maneuver use greatest in Middle Income countries
ARDS Demographics and Management
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• Duration of MV and ICU Length of Stay– Longer in Europe than in ROW HI countries (after adjustment for covariates)
– Not explained by differences in national SE status
– Differences in patient management [Tidal volume; Oxygen; Other?]
• No association between ICU level variables and Outcome– Effects not explained by differences in ICU organization or staffing
Effect of Income on Outcome in ARDS
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• Greater national per capita income was associated with increased patient survival from ARDS. – National rather than patient level indices [World Bank]
– Effects not explained by differences in ICU organization or staffing
• Association rather than ‘cause and effect’ linkage– Not necessarily reflecting differences in quality of critical care
– Potentially explained by differences in:• Access to critical care
• Public health / Preventive medicine
• Further evidence of effect of socioeconomic status on outcomes from critical illnesses
Income and Mortality in ARDS
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• Nearly 13,000 patients
• Over 1,000 LUNG SAFE Investigators in ICUs across the Globe– 666 ICUs registered patients for LUNG SAFE
– 475 ICUs validated patients into the study
• National coordinators in over 50 countries
• LUNG SAFE Steering Group and Executive Committee– Giacomo Bellani
– Tai Pham
– Eddy Fan
• ESICM
Thank You