The Epidemiology of Respiratory Failure in the United States 2002–2017: A Serial Cross-Sectional Study

Abstract

Objectives: Respiratory failure with mechanical ventilation is a limited labor-intensive resource that is associated with high mortality. Understanding the longitudinal national epidemiology is essential for the organization of healthcare resources. Design: Serial cross-sectional study. Setting: The 2002–2017 Healthcare Utilization Project’s National Inpatient Sample datasets. Interventions: None. Measurements: We use six diagnosis codes and five procedural codes from International Classification of Diseases, 9th Revision, Clinical Modification, and 19 diagnosis codes and 15 procedures codes from International Classification of Diseases, 10th Revision, Clinical Modification to examine national epidemiology of different case definitions for respiratory failure. Results: In the United States in 2017, there were an estimated 1,146,195 discharges with a diagnosis of respiratory failure and procedural code for mechanical ventilation, with an average length of stay of 10.5 days and hospital charge of $158,443. Over the study period, there was an 83% increase in incidence from 249 to 455 cases per 100,000 adults with a 48% decrease in hospital mortality from 34% to 23%. Exploring a case definition that captures only diagnosis codes for respiratory failure, there was a 197% increase in annual incidence, from 429 to 1,275 cases per 100,000 adults with a 57% decrease in hospital mortality from 28% to 12%. For invasive mechanical ventilation without a requisite diagnosis code, there was no change in incidence over the study period, with the 2017 incidence at 359 cases per 100,000 adults, but a 19% decrease in hospital mortality from 37% to 30%. For the noninvasive mechanical ventilation procedural codes, there was a 437% increase in incidence from 41 to 220 cases per 100,000 adults, with a 38% decrease in hospital mortality from 16% to 10%. Conclusions: Examining different case definitions for respiratory failure, there was a large increase in the population incidence and decrease in the hospital mortality for respiratory failure diagnosis codes with more modest changes procedural codes for invasive mechanical ventilation. There was a large increase in incidence of noninvasive mechanical ventilation.

The Epidemiology of Adult Tracheostomy in the United States 2002–2017: A Serial Cross-Sectional Study

“…First, we note that, unfortunately, the dataset is not able to assess the accuracy of or changes in coding practices, and this remains an important unknown factor in our results. In regard to changes in the underlying occurrence rate of RF-IMV, our previously published work in these data has demonstrated the annual occurrence rates of RF-IMV over the same study period ( 17 ). Briefly, among U.S. adults from 2002 to 2017, the occurrence rate of discharges with RF diagnoses increased nearly two-fold, occurrence rate of discharges with procedural codes for IMV remained stable, and discharges with RF and any mechanical ventilation (including non-IMV) increased 83% ( 17 ).…”

“…In regard to changes in the underlying occurrence rate of RF-IMV, our previously published work in these data has demonstrated the annual occurrence rates of RF-IMV over the same study period ( 17 ). Briefly, among U.S. adults from 2002 to 2017, the occurrence rate of discharges with RF diagnoses increased nearly two-fold, occurrence rate of discharges with procedural codes for IMV remained stable, and discharges with RF and any mechanical ventilation (including non-IMV) increased 83% ( 17 ). Although that work did not specifically describe the RF-IMV population of this study, it seems reasonable to infer that the underlying patient RF-IMV population for potential tracheostomy is stable to growing.…”

The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era

“…However, there are relatively few studies in the current era of lung-protective ventilation addressing epidemiological characteristics, patterns of ventilation, and clinical outcomes in AHRF patients without ARDS. Recent retrospective surveys using administrative databases have substantial limitations since they did not include specific hypoxemic conditions (13)(14)(15) or were focused on ARDS mortality (16,17). A 1-day point prevalence study conducted in 2016 in France (18) in hypoxemic ICU patients had a number of limitations, including the fact that arterial blood gases were not analyzed in 31% of patients on the study day.…”

Prone Positioning in Patients With Acute Respiratory Distress Syndrome and Other Respiratory Conditions: Challenges, Complications, and Solutions

“…In 2017, there was an estimated 1.14 million discharges from U.S. hospitals with a diagnosis of respiratory failure and mechanical ventilation. 7 Between 2002 and 2017 the incidence (i.e., new cases) increased from 249 to 455 cases per 100,000 adults and hospital mortality decreased from 34% to 23%. 7 Both conditions can result from inflammation and edema in the lungs that reduce the amount of oxygen getting into the blood and body's organs leading to hypoxemia, i.e., low blood oxygen levels.…”

“…7 Between 2002 and 2017 the incidence (i.e., new cases) increased from 249 to 455 cases per 100,000 adults and hospital mortality decreased from 34% to 23%. 7 Both conditions can result from inflammation and edema in the lungs that reduce the amount of oxygen getting into the blood and body's organs leading to hypoxemia, i.e., low blood oxygen levels. 3,[8][9][10][11][12][13][14] Sepsis, pneumonia, and shock are the most common ARDS risk factors.…”