Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery

Abstract

Objective: Patients requiring prolonged acute mechanical ventilation (PAMV, defined as mechanical ventilation > or = 96 hrs) have hospital survival rates similar to those requiring < 96 hrs of mechanical ventilation and consume about two thirds of hospital resources devoted to mechanical ventilation care. Because of this disproportionate resource utilization and the shifting U.S. demographics, we projected the expected volume of adult PAMV cases through year 2020.

Design: We used data from the National Inpatient Sample/Health Care Utilization Project of the Agency for Healthcare Research and Quality from 2000 to 2005 to calculate historic annual age-adjusted PAMV incidence rates using estimated population statistics from the U.S. Census Bureau. To predict future growth by age group, we fit linear regression models to the historic incidence rate changes. Age-adjusted estimates were computed using population projections obtained from the U.S. Census Bureau.

Setting: U.S. hospitals.

Patients: Nationally representative sample of U.S. hospital discharges with PAMV (code 96.72 from the International Classification of Diseases, Ninth Revision).

Interventions: None.

Measurements and main results: Historic annualized increase in PAMV was approximately 5.5%, compared with approximately 1% per annum growth in both U.S. population and hospital admissions. The fastest annualized growth was observed among 44-65 (7.9%) followed by 18-44 (4.7%), > or = 85 (4.6%), and 65-84 (3.4%) age groups. Factoring in both age-specific growth in PAMV population and overall U.S. adult population changes, we project PAMV to more than double from approximately 250,000 cases in 2000 to 605,898 cases by year 2020.

Conclusions: Patients undergoing PAMV are a large and resource-intensive population whose increase outpaces growth in the general U.S. population and in overall hospital volume. Policy makers must factor this projected rapid growth in frequency of PAMV into future resource and work force planning. Given the resource-intensive nature of these patients, strategies need to be developed to optimize their care and to increase efficiency of healthcare delivery to this large and growing population.