Intensive Care Unit versus High-dependency Care Unit for COVID-19 Patients with Invasive Mechanical Ventilation

Ohbe, Hiroyuki; Sasabuchi, Yusuke; Iwagami, Masao; Ogura, Takayuki; Ono, Sachiko; Matsui, Hiroki; Yasunaga, Hideo

doi:10.1513/annalsats.202206-475oc

Cited by 13 publications

(6 citation statements)

References 38 publications

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“…Guidelines for intensive care unit (ICU) admission recommend that patients receiving invasive mechanical ventilation (IMV) be treated in the ICU rather than outside the ICU [ 1 , 2 ]. This recommendation is supported by previous evidence showing lower in-hospital mortality rates in patients who received IMV in the ICU compared to those who were treated outside of it [ 3 , 4 ].…”

Section: Introductionsupporting

confidence: 62%

Hospital and regional variations in intensive care unit admission for patients with invasive mechanical ventilation

Ohbe,

Shime,

Yamana

et al. 2024

j intensive care

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Background Patients who receive invasive mechanical ventilation (IMV) in the intensive care unit (ICU) have exhibited lower in-hospital mortality rates than those who are treated outside. However, the patient-, hospital-, and regional factors influencing the ICU admission of patients with IMV have not been quantitatively examined. Methods This retrospective cohort study used data from the nationwide Japanese inpatient administrative database and medical facility statistics. We included patients aged ≥ 15 years who underwent IMV between April 2018 and March 2019. The primary outcome was ICU admission on the day of IMV initiation. Multilevel logistic regression analyses incorporating patient-, hospital-, or regional-level variables were used to assess cluster effects by calculating the intraclass correlation coefficient (ICC), median odds ratio (MOR), and proportional change in variance (PCV). Results Among 83,346 eligible patients from 546 hospitals across 140 areas, 40.4% were treated in ICUs on their IMV start day. ICU admission rates varied widely between hospitals (median 0.7%, interquartile range 0–44.5%) and regions (median 28.7%, interquartile range 0.9–46.2%). Multilevel analyses revealed significant effects of hospital cluster (ICC 82.2% and MOR 41.4) and regional cluster (ICC 67.3% and MOR 12.0). Including patient-level variables did not change these ICCs and MORs, with a PCV of 2.3% and − 1.0%, respectively. Further adjustment for hospital- and regional-level variables decreased the ICC and MOR, with a PCV of 95.2% and 85.6%, respectively. Among the hospital- and regional-level variables, hospitals with ICU beds and regions with ICU beds had a statistically significant and strong association with ICU admission. Conclusions Our results revealed that primarily hospital and regional factors, rather than patient-related ones, opposed ICU admissions for patients with IMV. This has important implications for healthcare policymakers planning interventions for optimal ICU resource allocation.

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Section: Introductionsupporting

confidence: 62%

Hospital and regional variations in intensive care unit admission for patients with invasive mechanical ventilation

Ohbe,

Shime,

Yamana

et al. 2024

j intensive care

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“…Reports have been published on efforts by some of the countries and regions we studied to cope with inadequate critical care capacity, including for example the rapid development of a national guideline for resource allocation in Thailand, 22 providing invasive mechanical ventilation in IMCUs and not just ICUs as a matter of routine in Japan, 23 and rapid discharge of less sick patients from ICUs in Mongolia. 24 Our findings add to the literature through demonstrating how the pandemic triggered various countries and regions to play catch-up for sheer bed capacity, with the gap between the number of beds per 100,000 population between middle-income and high-income economies narrowing substantially from 2017 (median of 2.6 versus 11.4) to 2022 (median of 6.6 versus 13.9).…”

Section: Discussionmentioning

confidence: 99%

Critical care bed capacity in Asian countries and regions before and during the COVID-19 pandemic: an observational study

Phua,

Kulkarni,

Mizota

et al. 2024

The Lancet Regional Health - Western Pacific

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“…Because all data were de-identified, the requirement for informed consent was waived. Similar studies have assessed the levels of intensive care in different populations (16,17).…”

Section: Study Design and Data Sourcementioning

confidence: 96%

Association Between Levels of Intensive Care and In-Hospital Mortality in Patients Hospitalized for Sepsis Stratified by Sequential Organ Failure Assessment Scores*

Ohbe

Sasabuchi

Doi

et al. 2023

Critical Care Medicine

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OBJECTIVES: To assess the association between levels of intensive care and in-hospital mortality in patients hospitalized for sepsis, stratified by Sequential Organ Failure Assessment (SOFA) score at admission. DESIGN: A nationwide, propensity score-matched, retrospective cohort study. SETTING: A Japanese national inpatient database with data on 70–75% of all ICU and high-dependency care unit (HDU) beds in Japan. PATIENTS: Adult patients hospitalized for sepsis with SOFA scores greater than or equal to 2 on their day of admission between April 1, 2018, and March 31, 2021, were recruited. Propensity score matching was performed to compare in-hospital mortality, and patients were stratified into 10 groups according to SOFA scores. INTERVENTIONS: Two exposure and control groups according to treatment unit on day of admission: 1) ICU + HDU versus general ward and 2) ICU versus HDU. MEASUREMENTS AND MAIN RESULTS: Of 97,070 patients, 19,770 (20.4%), 23,066 (23.8%), and 54,234 (55.9%) were treated in ICU, HDU, and general ward, respectively. After propensity score matching, the ICU + HDU group had significantly lower in-hospital mortality than the general ward group, among cohorts with SOFA scores greater than or equal to 6. There were no significant differences in in-hospital mortality among cohorts with SOFA scores 3–5. The ICU + HDU group had significantly higher in-hospital mortality than the general ward among cohorts with SOFA scores of 2. The ICU group had lower in-hospital mortality than the HDU group among cohorts with SOFA scores greater than or equal to 12. There were no significant differences in in-hospital mortality among cohorts with SOFA scores 5–11. The ICU group had significantly higher in-hospital mortality than the general ward group among cohorts with SOFA scores less than or equal to 4. CONCLUSIONS: Patients hospitalized for sepsis with SOFA scores greater than or equal to 6 in the ICU or HDU had lower in-hospital mortality than those in the general ward, as did those with SOFA scores greater than or equal to 12 in the ICU versus HDU.

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Intensive Care Unit versus High-dependency Care Unit for COVID-19 Patients with Invasive Mechanical Ventilation

Cited by 13 publications

References 38 publications

Hospital and regional variations in intensive care unit admission for patients with invasive mechanical ventilation

Hospital and regional variations in intensive care unit admission for patients with invasive mechanical ventilation

Critical care bed capacity in Asian countries and regions before and during the COVID-19 pandemic: an observational study

Association Between Levels of Intensive Care and In-Hospital Mortality in Patients Hospitalized for Sepsis Stratified by Sequential Organ Failure Assessment Scores*

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