Abstract
BackgroundIn most countries, patients receiving mechanical ventilation (MV) are treated in intensive care units (ICUs). However, in some countries, including Japan, many patients on MV are not treated in ICUs. There are insufficient epidemiological data on these patients. Here, we sought to describe the epidemiology of patients on MV in Japan by comparing and contrasting patients on MV treated in ICUs and in non-ICU settings. A preliminary comparison of patient outcomes between ICU and non-ICU patients was a secondary objective.MethodsData on adult patients receiving MV for at least 3 days in ICUs or non-ICU settings from April 2010 through March 2012 were obtained from the Quality Indicator/Improvement Project, a voluntary data-administration project covering more than 400 acute-care hospitals in Japan. We excluded patients with cancer-related diagnoses. Patient demographic data and the critical care provided were compared between groups.ResultsOver the study period, 17,775 patients on MV were treated only in non-ICU settings, whereas 20,516 patients were treated at least once in ICUs (46.4% vs. 53.6%). Average age was higher in non-ICU patients than in ICU patients (72.8 vs. 70.2, P < 0.001). Mean number of ventilation days was greater in non-ICU patients (11.7 vs. 9.5, P < 0.001). Hospital mortality was higher in non-ICU patients (41.4% vs. 38.8%, P < 0.001). Standard critical care (e.g., arterial line placement, enteral nutrition, and stress-ulcer prevention) was provided significantly less often in non-ICU patients. Multivariate analysis showed that ICU admission significantly decreased hospital mortality (adjusted odds ratio 0.713, 95% CI 0.676 to 0.753).ConclusionsA large proportion of Japanese patients on MV were treated in non-ICU settings. Analysis of administrative data indicated preliminarily that hospital mortality rates in these patients were higher in non-ICU settings than in ICUs. Prospective analyses comparing non-ICU and ICU patients on MV by severity scoring are needed.
Highlights
In most countries, patients receiving mechanical ventilation (MV) are treated in intensive care units (ICUs)
The percentage of men and the percentage of emergency admissions were significantly higher in ICU patients (P = 0.025, P < 0.001, respectively)
Overall hospital mortality was significantly higher in non-ICU patients than in ICU patients (7353 (41.4%) vs. 7963 (38.8%); P < 0.001)
Summary
Patients receiving mechanical ventilation (MV) are treated in intensive care units (ICUs). In some countries, including Japan, many patients on MV are not treated in ICUs. There are insufficient epidemiological data on these patients. The numbers of patients requiring intensive care are increasing worldwide [1] Many of these patients require mechanical ventilation (MV), and in a majority of countries they are treated exclusively in intensive care units (ICUs) [1, 2]. To the best of our knowledge, no epidemiological data on acute-phase patients on MV treated in non-ICU settings in Japan have been reported. Because of a lack of quantitative epidemiological data in the survey, no conclusion was drawn on what proportion of patients were being treated in non-ICU settings. We consider that the feasibility and safety of treating patients on MV in non-ICU settings is worth investigating in a well-designed study
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