In the Journals

Invasive mechanical ventilation has increased significantly since 1990

Invasive mechanical ventilation use increased significantly from 1993 to 2009, according to study results.

However, the utilization and outcomes of mechanical ventilation differed greatly based on a patients’ diagnosis, according to researchers.

Anuj B. Mehta, MD, a fourth-year fellow at Boston University School of Medicine, and colleagues analyzed data from the U.S. Agency for Healthcare and Research Quality’s Healthcare and Utilization Project’s Nationwide Inpatient Sample to determine nationwide trends in invasive mechanical ventilation (IMV) and to assess for disease-specific variation for pneumonia, heart failure and COPD.

The analysis included 8,309,344 cases of IMV from 1993 to 2009. IMV use increased from 178.8 cases per 100,000 adults in 1993 to 310.9 per 100,000 in 2009 (P < .0001). Patients with pneumonia accounted for the largest increase in IMV use during the study period (103.6%). While patients with heart failure had a 55.4% decrease in IMV over the study period.

Overall mortality decreased in patients receiving IMV from 43.5% in 1993 to 32.2% in 2006. However, patients with different diagnoses had different results. Mortality every 5 years decreased in patients with pneumonia (aOR = 0.89; 95% CI, 0.88-0.9) and COPD (aOR = 0.97; 95% CI, 0.97-0.98).

However, mortality in patients with heart failure increased (aOR = 1.1; 95% CI, 1.09-1.12).

Improvements in mortality may be overestimated as patients receiving IMV may have been transferred earlier and more often to long-term care, according to the researchers.

“Deaths occurring at long-term care facilities soon after acute hospital discharge were not captured, further studies investigating mortality at 30 days or 1-year time points are warranted,” the researchers wrote. – by Ryan McDonald

Disclosure: The researchers report no relevant financial disclosures.

Invasive mechanical ventilation use increased significantly from 1993 to 2009, according to study results.

However, the utilization and outcomes of mechanical ventilation differed greatly based on a patients’ diagnosis, according to researchers.

Anuj B. Mehta, MD, a fourth-year fellow at Boston University School of Medicine, and colleagues analyzed data from the U.S. Agency for Healthcare and Research Quality’s Healthcare and Utilization Project’s Nationwide Inpatient Sample to determine nationwide trends in invasive mechanical ventilation (IMV) and to assess for disease-specific variation for pneumonia, heart failure and COPD.

The analysis included 8,309,344 cases of IMV from 1993 to 2009. IMV use increased from 178.8 cases per 100,000 adults in 1993 to 310.9 per 100,000 in 2009 (P < .0001). Patients with pneumonia accounted for the largest increase in IMV use during the study period (103.6%). While patients with heart failure had a 55.4% decrease in IMV over the study period.

Overall mortality decreased in patients receiving IMV from 43.5% in 1993 to 32.2% in 2006. However, patients with different diagnoses had different results. Mortality every 5 years decreased in patients with pneumonia (aOR = 0.89; 95% CI, 0.88-0.9) and COPD (aOR = 0.97; 95% CI, 0.97-0.98).

However, mortality in patients with heart failure increased (aOR = 1.1; 95% CI, 1.09-1.12).

Improvements in mortality may be overestimated as patients receiving IMV may have been transferred earlier and more often to long-term care, according to the researchers.

“Deaths occurring at long-term care facilities soon after acute hospital discharge were not captured, further studies investigating mortality at 30 days or 1-year time points are warranted,” the researchers wrote. – by Ryan McDonald

Disclosure: The researchers report no relevant financial disclosures.