Respiratory failure & ventilation
Hospital and regional variations in intensive care unit admission for patients with invasive mechanical ventilation
Authors' conclusion
Our results revealed that primarily hospital and regional factors, rather than patient-related ones, opposed ICU admissions for patients with IMV.
Study context
- Population
- Patients aged ≥ 15 years who underwent invasive mechanical ventilation (IMV), nationwide Japanese inpatient database, April 2018–March 2019140 areas
- Participants
- 83,346 patients · 546 hospitals
- Outcome
- ICU admission on the day of IMV initiation
Methodological detailsnationwide administrative database, multilevel logistic regression
- Nationwide administrative database
- Multilevel logistic regression
Main finding
As reported in the abstract
ICU admission on IMV start day
- Treated in intensive care unit (ICUs) on IMV start day
- 40.4%
- ICU admission rate between hospitals, median (IQR 0-44.5%)
- 0.7%
- ICU admission rate between regions, median (IQR 0.9-46.2%)
- 28.7%
- Hospital cluster intraclass correlation coefficient (ICC)
- 82.2%
- Hospital cluster median odds ratio (MOR)
- 41.4
- Regional cluster ICC
- 67.3%
- Regional cluster MOR
- 12.0
Observational data: associations, not effects.
Further findings
Adjustment for patient-level variables
- ICCs and MORs unchanged; Proportional change in variance (PCV) hospital
- 2.3%
- PCV regional
- - 1.0%
Further adjustment for hospital- and regional-level variables
- ICC and MOR decreased; PCV hospital
- 95.2%
- PCV regional
- 85.6%
- Hospitals with ICU beds and regions with ICU beds significantly and strongly associated with ICU admission
Original publication
Hospital and regional variations in intensive care unit admission for patients with invasive mechanical ventilation. J Intensive Care. Published 5 June 2024. doi:10.
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