Use of Mechanical Ventilation Across 3 Countries.

Autor:	Jivraj NK; Interdepartmental Division of Critical Care Medicine, University of Toronto, Ontario, Canada.; Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada., Hill AD; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Shieh MS; Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School, Baystate, Springfield, Massachusetts., Hua M; Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York., Gershengorn HB; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida.; Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York., Ferrando-Vivas P; Intensive Care National Audit & Research Centre, Napier House, London, United Kingdom., Harrison D; Intensive Care National Audit & Research Centre, Napier House, London, United Kingdom., Rowan K; Intensive Care National Audit & Research Centre, Napier House, London, United Kingdom., Lindenauer PK; Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School, Baystate, Springfield, Massachusetts., Wunsch H; Interdepartmental Division of Critical Care Medicine, University of Toronto, Ontario, Canada.; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	JAMA internal medicine [JAMA Intern Med] 2023 Aug 01; Vol. 183 (8), pp. 824-831.
DOI:	10.1001/jamainternmed.2023.2371
Abstrakt:	Importance: The ability to provide invasive mechanical ventilation (IMV) is a mainstay of modern intensive care; however, whether rates of IMV vary among countries is unclear. Objective: To estimate the per capita rates of IMV in adults across 3 high-income countries with large variation in per capita intensive care unit (ICU) bed availability. Design, Setting, and Participants: This cohort study examined 2018 data of patients aged 20 years or older who received IMV in England, Canada, and the US. Exposure: The country in which IMV was received. Main Outcomes and Measures: The main outcome was the age-standardized rate of IMV and ICU admissions in each country. Rates were stratified by age, specific diagnoses (acute myocardial infarction, pulmonary embolus, upper gastrointestinal bleed), and comorbidities (dementia, dialysis dependence). Data analyses were conducted between January 1, 2021, and December 1, 2022. Results: The study included 59 873 hospital admissions with IMV in England (median [IQR] patient age, 61 [47-72] years; 59% men, 41% women), 70 250 in Canada (median [IQR] patient age, 65 [54-74] years; 64% men, 36% women), and 1 614 768 in the US (median [IQR] patient age, 65 [54-74] years; 57% men, 43% women). The age-standardized rate per 100 000 population of IMV was the lowest in England (131; 95% CI, 130-132) compared with Canada (290; 95% CI, 288-292) and the US (614; 95% CI, 614-615). Stratified by age, per capita rates of IMV were more similar across countries among younger patients and diverged markedly in older patients. Among patients aged 80 years or older, the crude rate of IMV per 100 000 population was highest in the US (1788; 95% CI, 1781-1796) compared with Canada (694; 95% CI, 679-709) and England (209; 95% CI, 203-214). Concerning measured comorbidities, 6.3% of admitted patients who received IMV in the US had a diagnosis of dementia (vs 1.4% in England and 1.3% in Canada). Similarly, 5.6% of admitted patients in the US were dependent on dialysis prior to receiving IMV (vs 1.3% in England and 0.3% in Canada). Conclusions and Relevance: This cohort study found that patients in the US received IMV at a rate 4 times higher than in England and twice that in Canada in 2018. The greatest divergence was in the use of IMV among older adults, and patient characteristics among those who received IMV varied markedly. The differences in overall use of IMV among these countries highlight the need to better understand patient-, clinician-, and systems-level choices associated with the varied use of a limited and expensive resource.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu