Epidemiology, Patterns of Care, and Mortality for ...

Supplementary Online Content Bellani G, Laffey JG, Pham T, et al; for LUNG SAFE Investigators and ESICM Clinical Trials group. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. doi: 10.1001/jama.2016.0291

eTable 1. Characteristics of participating ICUs eTable 2. Amount of missing data for each variable included in the analysis eTable 3. Participating ICUs and patients validated by continent and country eTable 4. Ventilation of patients with recognized versus unrecognized ARDS eTable 5. Factors included in bivariable and multivariable analyses eTable. 6. Patient and organizational factors associated with Higher VT eTable. 7. Patient and organizational factors associated with Pplat measurement eTable. 8. Patient and organizational factors associated with higher PEEP eTable. 9. Patient and organizational factors associated with prone positioning eTable 10. Patient and organizational factors associated with neuromuscular blockade eFigure 1. Arterial CO2 tension, arterial pH, tidal volume and plateau pressures in patients with ARDS eFigure 2. Ventilation parameters in patients in whom plateau pressure was recorded on the first day of ARDS eFigure 3. Distribution of Ventilator Free Days in patients with ARDS eAppendix 1. National Coordinators and National Societies/Networks endorsements eAppendix 2. List of LUNG SAFE Investigators eAppendix 3. LUNG SAFE Protocol, Statistical Analysis Plan and Case Report Form eReferences

This supplementary material has been provided by the authors to give readers additional information about their work.

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eTable 1. Characteristics of LUNG SAFE participating ICUs

Number of ICUs providing this data1

Median [IQR]

408

588 [320-943]

417

13.0 [9.0-20.0]

395

717 [441-1100]

393

53 [39-68]

410

22.0 [12-47]

357

52 [31-82]

343

7.87 [6.0-9.7]

Nurse to bed ratio (daytime)

397

0.67 [0.48-1.00]

Staff doctors to bed ratio (daytime)

399

0.25 [.12-.40]

387

0.50 [.35-.79]

Variable

Total number of beds in the hospital of the ICUs participating to the study Number of beds in the ICUs participating to the study Number of ICU admissions in year prior to study (i.e. in 2013) Number of ICU Admissions per bed in in year prior to study (i.e. in 2013) Total number of ICU beds in the hospital2 Number of patients admitted to the ICU during the study Patients admitted in the ICU during the study (expressed as % of 2013)

Ratio of total doctors (staff. residents. fellows) to beds (daytime) 1

A total of 459 ICUs from 435 hospitals participated in this study..

2

The total number of ICU beds in the hospital, includes the bed from all the ICUs in the hospital, irrespective of whether or not they participated in the study. This data was provided by 396 hospitals.

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eTable 2. Amount of missing data for each variable included in the analysis Missing data (n)

Missing data (%)

Age

0

0%

ARDS risk factors

0

0%

Comorbidities

0

0%

FiO2

0

0%

PaO2

0

0%

P/F

0

0%

PEEP

0

0%

Type of admission

0

0%

Respiratory rate

10

0%

SOFA score

20

1%

PaCO2

25

1%

pH

25

1%

Standardized Minute Ventilation

55

2%

Peak inspiratory pressure

89

4%

PBW

99

4%

Vt/PBW

122

5%

Actual body weight

124

5%

SpO2

847

36%

Abbreviations. ARDS: Acute Respiratory Distress Syndrome, SOFA: Sequential Organ Failure Assessment, Vt: Tidal Volume, PBW : Predicted Body Weight, PEEP: Positive End-Expiratory Pressure, PaO2: arterial oxygen tension; P/F: PaO2/FiO2, SpO2: peripheral arterial oxygen saturation

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eTable 3. Geographic distribution of participating ICUs and enrolled patients Country Africa

Participating ICUs Enrolled patients N N 10

169

Morocco

5

48

South Africa

1

70

Tunisia

4

51

89

2,268

Brunei Darussalam

1

21

China

35

1,181

India

10

206

Iran

2

61

Japan

28

643

Lebanon

1

1

Malaysia

1

6

Philippines

2

18

Russian Federation

2

11

Saudi Arabia

7

120

241

6,996

Albania

2

32

Austria

1

18

Belgium

6

145

Czech Republic

1

24

Denmark

2

70

France

41

1,312

Germany

6

275

Greece

5

100

Ireland

8

277

Italy

32

752

Latvia

1

19

Netherlands

7

412

Norway

4

116

Asia

Europe

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Country

Participating ICUs Enrolled patients N N

Poland

1

13

Portugal

11

247

Romania

3

106

Serbia

3

56

Spain

45

1,030

Sweden

10

330

Switzerland

2

136

Turkey

4

85

United Kingdom

46

1,441

57

1,974

Canada

8

380

Costa Rica

2

30

Guatemala

2

25

Mexico

10

118

United States

35

1,421

18

837

Australia

12

695

New Zealand

6

142

South America

44

662

Argentina

18

280

Brazil

8

47

Chile

7

116

Colombia

1

89

Ecuador

2

2

Peru

2

51

Uruguay

6

77

459

12,906

North America

Oceania

Total

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eTable 4. Ventilation of invasively ventilated patients with recognized versus unrecognized ARDS Extent of ARDS Recognition

All

Mild

Moderate

Severe

(n=2377)

(n=714; 30.0%)

(n=1106; 46.5%)

(n=557; 23.4%)

ARDS Recognition at any time No. (%) (95% CI) Effect of ARDS Recognition on Day 1 variables

1525 (64.2%) (62.2-66.1)

366 (51.3%) (47.5-55.0)

722 (65.3%) (62.4-68.1)

437 (78.5%) (74.8-81.8)

Tidal volume (ml/kg PBW) - ARDS Recognized, mean (95% CI) - ARDS Unrecognized, mean (95% CI) PEEP (cmH2O) - ARDS Recognized , mean (95% CI) - ARDS Unrecognized, mean (95% CI) Peak Pressure (cmH2O)2 - ARDS Recognized, mean (95% CI) - ARDS Unrecognized, mean (95% CI)

P=0.014 7.5 (7.4-7.6) 7.7 (7.6-7.9) P