Epidemiology of mechanically ventilated patients treated in ICU and non-ICU settings in Japan: a retrospective database study

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.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2250-3) contains supplementary material, which is available to authorized users.

Clinical Characteristics of Mechanically Ventilated Patients Treated in Non-ICU Settings in Japan: A Retrospective Analysis

“…Previously, we showed that 46.4% of these patients (including those with noninvasive MV) are treated in non-ICU settings in Japan (2). The mortality rate of these patients was higher than in those treated in ICU settings.…”

History and Profile of Diagnosis Procedure Combination (DPC): Development of a Real Data Collection System for Acute Inpatient Care in Japan

“… 16 Iwashita et al clarified the differences in the duration of the use of a mechanical ventilator, mortality rate, and intensive care treatment implementation status depending on admission to an intensive care unit. 17 Kuwabara et al investigated the relationship between the use of albumin and catecholamines for subarachnoid hemorrhage and in-hospital mortality, consciousness deterioration at discharge, and reintubation rate. 18 Kido et al conducted a comparative study on the differences in in-hospital mortality in patients with acute lung injury and acute respiratory distress syndrome based on the administration of sivelestat.…”

Invasive mechanical ventilation in the emergency department

“…The square waveform or decelerating inspiratory flow for the inspiratory flow-time profile are commonly used. For volume targeted ventilation, apart from FiO 2 , PEEP, trigger mode and sensitivity, 1 V T 2 ; inspiratory waveform 3 ; mandatory respiratory rate [f] 4 ; and timing such as inspiratory/expirium ratio or inspiratory time/total breathing time and inspiratory time (T i ) is set 29 …”

“…A one-quarter of these patients remain in the ED for more than 5 hours, and their mortality is significantly higher than the other patients admitted to the ICU 2 . In Japan, it is reported that 46.4% of patients 3 requiring MV are monitored in non-ICU settings. EDs is one of these places that frequently monitor mechanically ventilated patients.…”