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

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. Methods: In 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: middle-income 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\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; 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\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). 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. Funding: No funding

Efeito da luminosidade e da adição de nitrogênio no crescimento de plantas de Ilex paraguariensis St. Hil. Effect of light and nitrogen on the growth of Ilex paraguariensis St. Hil.

Neste trabalho, buscou-se identificar o efeito de diferentes níveis de luminosidade e da adição de adubo nitrogenado sobre o crescimento das plantas de erva-mate, no primeiro ano de crescimento. No experimento, usou-se o delineamento de blocos ao acaso, com três repetições, em quatro tratamentos e dois subtratamentos, tendo 16 parcelas por bloco. O esquema adotado foi o fatorial, tendo como variável constante a luminosidade em quatro intensidades (100, 70, 50 e 30%) e o nitrogênio como variável interveniente sobre as parcelas. As leituras foram efetuadas a cada 45 dias, em três horários diários por três dias consecutivos, durante um ano. Verificou-se que a condição mais adequada para o crescimento das plantas foi com luminosidades de 50 e 30%. A adição de nitrogênio não mostrou influência relevante no crescimento da erva-mate, especialmente nas luminosidades de 100 e 70%, enquanto o aumento da luminosidade tendeu a reduzir o crescimento das plantas. Contudo, as plantas adubadas (1N) tiveram maior rebrota que aquelas não-adubadas. A adição de nitrogênio mineral, em dosagens elevadas, foi danosa para as plantas de erva-mate, acarretando a mortalidade nas parcelas com tratamentos de maior luminosidade.<br>This paper aimed to evaluate the effect of different levels of luminosity and nitrogen addition on the height of mate plants in the first year of growth. The experiment was arranged in randomized blocks, with three replicates, in four treatments and two sub-treatments, in a total of 16 plots per block, in a factorial design, with the luminosity in four different intensities (100%, 70%, 50% and 30%) and the nitrogen application as the intervening variable on the plots. Data were collected every 45 days, in three daily schedules during three consecutive days, over one year. It was found that the best conditions to plant growth were 50% and 30% luminosity. The nitrogen addition have no relevant influence in plant growth, particularly at 100% and 70% luminosity, while the increase in luminosity contributed to the reduction in plant growth. However, the fertilized plants (1N) increased regrowth. Nitrogen addition at high doses damaged the mate plants and caused death of mate plants in the plots with higher luminosity