Increased ventilator utilization, ventilator-associated pneumonia, and mortality in non-COVID patients during the pandemic

Abstract

Background: This study examined ventilator utilization, ventilator-associated pneumonia (VAP) incidence, and mortality among non-COVID patients requiring mechanical ventilation during 2019 and 2020.

Methods: The Nationwide Inpatient Sample database was queried for adult hospitalizations with mechanical ventilation using ICD-10 procedure codes, excluding COVID-19 patients and minors. VAP rates were calculated per 1000 adults ventilated. Outcomes included ventilation rates, VAP incidence, and mortality odds between prepandemic and pandemic-exposed hospitalizations.

Results: Analyzing 1,533,775 hospitalizations, the pandemic-exposed had more male patients (57.6% vs 56.2%, P < 0.001) and nonelective admissions (95.4% vs 94.1%; P < 0.001). Non-COVID patients had a 4.5% increase in ventilator utilization in the pandemic compared with the prepandemic period (P < 0.001). Pandemic VAP incidence was 17 cases per 1000 adults ventilated, compared to 11 cases in the prepandemic period (P < 0.001). Mortality rates increased from 26.9% to 31.4%, with 314 mortalities per 1000 ventilated pandemic patients compared with 269 in the prepandemic period (adjusted odds ratio 1.13; 95% confidence interval 1.12-1.15; P < 0.001).

Conclusion: Significant ventilator utilization, VAP rates, and mortality increases occurred during the COVID-19 pandemic.

Keywords: COVID-19 pandemic; mechanical ventilation; mortality; ventilator-associated pneumonia.