Get To Know LOGIC: The World’s Largest Intensive Care Benchmarking Platform
LOGIC (Linking of Global Intensive Care) is an independent consortium of databases of large ICU networks and national records of quality in intensive care medicine. LOGIC aims to connect ICUs to promote quality improvement through international benchmarking and collaborative research, assisting in data-driven decision-making.
The project brings together some of the largest national records databases in the world. Through a shared online platform, researchers and ICU networks have easy access to aggregated data on ICU admissions worldwide, and to information updated annually.
LOGIC’s international benchmarking is a powerful assessment tool in intensive care and quality improvement, where all users of participating networks can compare the performance of ICUs and thus, increase epidemiology and outcome knowledge.
Logic is currently present in more than 13 countries, such as Brazil, Uruguay, The Netherlands, India, Australia, France, among others, with more than 2,000 ICUs monitored, adding more than 7 million admissions to these units since the beginning of the project, which offers an international approach to ICU benchmarking in a pragmatic and valuable way for physicians and researchers.
A Pooled Analysis Of Four Observational Studies
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.
Pisani L, Algera AG, Neto AS, Azevedo L, Pham T, Paulus F, de Abreu MG, Pelosi P, Dondorp AM, Bellani G, Laffey JG, Schultz MJ; ERICC study investigators; LUNG SAFE study investigators; PRoVENT study investigators; PRoVENT-iMiC study investigators.
Abstract
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 (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001).
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.
Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Conflict Of Interest Statement
Declaration of interests We declare no competing interests.
Development Of A Core Outcome Set For General Intensive Care Unit Patients – Need For A Broader Context?
Development of a core outcome set for general intensive care unit patients – need for a broader context?
Pari V, Beane A, Salluh JI, Donglemans DA.Acta Anaesthesiol Scand. 2022 Jan 28. doi: 10.1111/aas.14031. Online ahead of print.
by: The LOGIC Team