Global Burden of Mechanical Ventilation (GEMINI Study): An Epidemiological and Geo-economic Modelling Study

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Abstract RATIONALE: A routine clinical practice in adult critically ill patients receiving invasive mechanical ventilation (IMV) may be difficult to define. Our goal was to report updated global, and country-specific estimates of incidence, mortality, and case-fatality rates. METHODS: An observational prospective cohort of consecutive adult patients admitted between October 1, 2022, and April 30, 2023 to 457 intensive care units (ICU) from 42 countries who received IMV longer than 12 hours. Data were collected on each patient at initiation of mechanical ventilation and daily throughout the course of IMV for up to 28 days. RESULTS: During the period of recruitment, 8,350 patients were enrolled. A total of 6,998 patients from lower-middle income countries (1,428 patients), upper-middle countries (1930 patients) and high-income countries (3,640 patients) were included. Patients were predominantly males (63%) with a median age of 64 years (IQR 50,74) and median SAPS3 64 points (IQR 52-77). Main reasons for IMV were: neurologic disease (20%), postoperative respiratory insufficiency (16%), community acquired pneumonia (10%), sepsis (9%), cardiac failure (7%), ARDS (6%), COPD (5%), nosocomial pneumonia (5%), COVID (3%). Ventilator setting registered were: Tidal volume (median, IQR 7.4; 6.6-8.3 ml/kgPBW), plateau pressure (18; 15-22 cmH2O), applied PEEP (6; 5-8 cmH2O), driving pressure (12; 9-15 cmH2O), mechanical power (15.7; 11.9-20.8 joules/min). A lung protective strategy was applied on 79% of monitoring days and an open Lung Approach on 25% of monitoring days. Patients received sedation on 80% of the monitored days, analgesia on 77% and neuromuscular blocking on 9%. Most prevalent complications during the course of mechanical ventilation were sepsis (17%), delirium (14%), ventilator-associated pneumonia (8%), ARDS (8%) and ICU acquired weakness (8%). Other complications as thromboembolic events, tracheobronchitis, bleeding ulcus stress or Clostridium infection had a prevalence lower than 2%. 73% of the patients had at least one organ dysfunction, the most frequent of which were cardiovascular failure (66%), renal failure (24%), hematological failure (12%) and hepatic failure (9%). Comparison of outcomes according to income country is shown in table 1. CONCLUSIONS: After the pandemic COVID-19, we found significant geo-economic differences in the clinical outcomes of critically ill patients requiring IMV. Further adjusted models will provide information about the usual care of mechanically ventilated patients and variables related with poor outcomes.

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