The Changing Epidemiology of Mechanical Ventilation: A Population-Based Study

The number of critical care beds in the United States has been increasing considerably, but it is unclear how these additional beds have been used. Mechanical ventilation for acute respiratory failure almost always demands ICU care and is likely to be a reliable indicator of critical care resource requirements on a population level. The objective of this study was to measure changes in the yearly incidence of mechanical ventilation in a statewide population. The North Carolina Hospital Discharge Database contains data on all discharges from nonfederal, nonpsychiatric hospitals in North Carolina. Authors extracted data on adult patients with International Classification of Diseases, 9th Revision, Clinical Modification procedure codes for mechanical ventilation from 1996 to 2002. The incidence of mechanical ventilation for adults grew from 284/100 000 population in 1996 to 314/100 000 in 2002, an increase of 11% (P < .05). While patients aged >64 had the highest age-specific incidence of mechanical ventilation each year, the greatest increase in incidence occurred in younger age groups (19% increase for age 18-64 vs 4% increase for age >64). The mean Charlson score increased from 1.76 ± 1.73 to 1.89 ± 1.86 (P < .001). Renal disease became more prevalent among patients requiring mechanical ventilation (17% of patients in 1996 vs 24% in 2002). Hospital charges adjusted for the medical consumer price index increased by 12%. The proportion of patients discharged to home declined from 45.4% to 34.4%, and discharges to nursing homes grew from 7.3% to 10.7%. The incidence of mechanical ventilation is increasing, and the increase is associated with a higher burden of comorbidities and fewer discharges to home.

[1]  N. Halpern,et al.  Critical care medicine in the United States 1985–2000: An analysis of bed numbers, use, and costs* , 2004, Critical care medicine.

[2]  J. Cuzick,et al.  A Wilcoxon-type test for trend. , 1985, Statistics in medicine.

[3]  Shannon S Carson,et al.  Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993–2002 , 2004, Critical care medicine.

[4]  M. Laski,et al.  Outcomes research in dialysis. , 2003, Seminars in nephrology.

[5]  P. Pronovost,et al.  Mechanical ventilation in Ontario, 1992–2000: Incidence, survival, and hospital bed utilization of noncardiac surgery adult patients* , 2004, Critical care medicine.

[6]  L. Cooper,et al.  Medicare intensive care unit use: Analysis of incidence, cost, and payment* , 2004, Critical care medicine.

[7]  J. Neter,et al.  Applied linear statistical models : regression, analysis of variance, and experimental designs , 1974 .

[8]  W. Tarnow-Mordi,et al.  Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit , 2000, The Lancet.

[9]  M. Wysocki,et al.  Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. , 2001, American journal of respiratory and critical care medicine.

[10]  Arthur S Slutsky,et al.  One-year outcomes in survivors of the acute respiratory distress syndrome. , 2003, The New England journal of medicine.

[11]  C. Goldfrad,et al.  Consequences of discharges from intensive care at night , 2000, The Lancet.

[12]  R. Engelman,et al.  Fast-track recovery of the coronary bypass patient. , 1994, The Annals of thoracic surgery.

[13]  J. Hay.  Hospital cost drivers: an evaluation of 1998-2001 state-level data. , 2003, The American journal of managed care.

[14]  M. Bullinger,et al.  Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. , 1998, Critical care medicine.

[15]  D. Mannino,et al.  The epidemiology of sepsis in the United States from 1979 through 2000. , 2003, The New England journal of medicine.

[16]  D C Angus,et al.  Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? , 2000, JAMA.

[17]  J. Heffner,et al.  Attitudes and perceptions of internal medicine residents regarding pulmonary and critical care subspecialty training. , 2004, Chest.

[18]  J. Lee,et al.  Optimizing timing of early extubation in coronary artery bypass surgery patients. , 2000, Annals of Thoracic Surgery.

[19]  David Wennberg,et al.  The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care , 2003, Annals of Internal Medicine.

[20]  C. Brun-Buisson,et al.  Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. , 1999, JAMA.

[21]  C. Tilquin,et al.  Risk Adjustment in Outcome Assessment: the Charlson Comorbidity Index , 1993, Methods of Information in Medicine.

[22]  J. Oehler,et al.  Job stress and burnout in acute and nonacute pediatric nurses. , 1992, American Journal of Critical Care.

[23]  D C Angus,et al.  Quality-adjusted survival in the first year after the acute respiratory distress syndrome. , 2001, American journal of respiratory and critical care medicine.

[24]  C. Behrendt.  Acute respiratory failure in the United States: incidence and 31-day survival. , 2000, Chest.

[25]  S. Keenan,et al.  Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis. , 1997, Critical care medicine.