Respiratory failure & ventilation
Between-hospital variation in liberation from invasive mechanical ventilation: Consequences of ignoring death as a competing risk
Authors' conclusion
Benchmarking ventilation duration without treating death as a competing event misses the units that are failing to liberate patients, and those units have higher mortality.
Study context
- Population
- Adults starting invasive ventilation at 114 US hospitals in the eICU Collaborative Research Database
- Participants
- 43,880 adults · 114 US hospitals
- Exposure
- Competing-risk metric vs Conventional metric
- Outcome
- Hospital-specific, risk- and reliability-adjusted cumulative incidence of liberation, with death as a competing event
- Follow-up
- Day 7
Methodological detailsmulticentre, competing-risk analysis, overdispersion-adjusted funnel plots
- Multicentre
- Competing-risk analysis
- Overdispersion-adjusted funnel plots
Main finding
As reported in the abstract
Cumulative incidence of liberation
- Patients liberated
- 72.9%
- Patients died
- 11.4%
- Patients remained ventilated
- 15.7%
- Risk-standardised 7-day liberation across hospitals, range
- 26.7% to 85.8%
- Risk-standardised 7-day liberation across hospitals, median
- 70.7%
Observational data: associations, not effects.
Further findings
Explained between-hospital variance
- Case mix
- 3.7%
- Hospital structure and measurable processes, combined (further)
- 31.6%
Agreement between the two metrics
- Hospital ranking, only moderately alike (Spearman rho)
- 0.79
- Agreement on outliers at matched limits (weighted kappa)
- 0.00
- Agreed on no outlier at matched limits
Outlier hospitals by metric
- Conventional metric: better than expected
- 26
- Conventional metric: worse than expected
- 11
- Competing-risk metric: better than expected
- 3
- Competing-risk metric: worse than expected
- 26
Hospitals with significantly worse liberation unflagged by the conventional metric
- Unflagged hospitals
- 16 (14%)
- Risk-standardised ICU mortality, unflagged hospitals vs other
- 18.2% versus 13.6%
- p < 0.001
Original publication
Between-hospital variation in liberation from invasive mechanical ventilation: Consequences of ignoring death as a competing risk. J Crit Care. Published 13 September 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →