Figures
- Figure 1
Landscape of respiratory infections. CAP: community-acquired pneumonia; HAP: hospital-acquired pneumonia; VAP: ventilator-associated pneumonia; MDR: multidrug-resistant.
- Figure 2
Scheme of ICUAP. VA-LRTI: ventilator-associated lower respiratory tract infection; MV: mechanical ventilation.
Tables
- Table 1
Aims of ENIRRI
To create a global database of patients with IRRIs in order to facilitate epidemiological and clinical research, and recruitment into clinical trials To attract new researchers into the IRRIs through presentations at the ERS International Congress, and dissemination of research priorities and knowledge To support and encourage early career researchers, many of who are applicants in this proposal, through multidisciplinary training opportunities and participation at senior levels in network activities To facilitate applications to industry and EU sources to build IRRI research capacity in Europe and beyond To build a network of experts in IRRI management who will determine the need for a task force, and the need for an IRRI consensus statement or guidelines for diagnosis, prevention and management EU: European Union.
- Table 2
Sources of heterogeneity: LMIC particularities
Baseline age, comorbidities and performance status Age, comorbidities and previous performance status are important determinants of critical care outcome Baseline health status and comorbidities have a different profile in LMICs when compared to HICs [7, 8] ICU admission policies Patients may be more prone to be admitted to the ICU according to bed availability or admission policies Paucity of ICU beds in Latin American and other LMICs may compromise appropriate timing for ICU admission and result in higher mortality [9, 10] Local practices in mechanical ventilation Some units may choose to start mechanical ventilation early and/or may adopt early weaning protocols; thereby, duration of mechanical ventilation may vary Ventilator settings may also be different (i.e. tidal volume) Mortality of acute respiratory failure is high in LMICs and adherence to best practices may be lower [11, 12] Diagnostic technique availability Diagnostic techniques may vary between centres and countries LMICs may have restricted access to basic and advanced diagnostic methods [10] Microbiological profile Causative pathogen is associated with outcome in nosocomial pneumonia Gram-negative rods (including MDR pathogens) are more common in LMICs, especially Latin America [13] Initial empirical antimicrobial therapy Lack of adherence to early antimicrobial therapy may impact clinical outcomes Sepsis awareness is lower in LMICs [14] Use of prevention strategies Several prevention strategies may be effective in preventing nosocomial pneumonia, especially VAP (subglottic suctioning tubes, coated tubes, etc.) Limited availability of some devices in LMICs Lack of availability of single rooms in some settings [15] EOL preferences EOL policies vary between different countries and between different cultures This may result in changes in outcome estimates Physicians in Latin America may be less prone to establish clear EOL policies and to discuss treatment directives with patients and relatives [16] HIC: high-income country; EOL: end-of-life.
Supplementary Material
S. Aliberti EDU-0092-2017_Aliberti
Vol 13 Issue 3
Table of Contents
Respiratory research networks in Europe and beyond: aims, achievements and aspirations for the 21st century
