Assessing delivery of mechanical ventilation: risks and benefits of large databases
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EDITORIAL
Assessing delivery of mechanical ventilation: risks and benefits of large databases May Hua1,2, Hayley B. Gershengorn3,4 and Hannah Wunsch1,5,6* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Invasive mechanical ventilation is a key component of critical care medicine. Resource-intensive and expensive, it is an essential intervention to support many patients through critical illness. Examining and estimating system-wide capacity for mechanical ventilation, whether the system in question is a country, a region, or a group of hospitals, is often accomplished using population-level data. These data may be used to assess whether capabilities match current or projected needs, and may be used to evaluate differences in use and outcomes across a system or systems [1–3].
Specific uses for population‑level data Population-level data are often used to better understand the epidemiology and outcomes of mechanical ventilation. Such data have demonstrated that patients requiring mechanical ventilation span a wide age range, are highly comorbid, and account for an outsize percentage of overall hospital costs [4]. Studies across hospitals have shown substantial variation in use of mechanical ventilation and demonstrated the possibility of a volume–outcome relationship, with lower mortality at hospitals with higher rates of use [5, 6]. Population-level data have also been used to understand temporal trends in use of mechanical ventilation. Over time, use of mechanical ventilation has increased and the treated population has changed, with patients having a higher severity of illness [1, 7]. Furthermore, in the United States, the use of tracheostomy also increased (until 2008), with a concomitant increase in the use of post-acute care facilities [7, 8]. Recognition of these trends was important, as they informed the need to move beyond in-hospital endpoints to follow patients *Correspondence: [email protected] 1 Department of Anesthesiology, Columbia University, New York, NY, USA Full author information is available at the end of the article
post discharge to fully understand mechanical ventilation outcomes. Moreover, tracking of these trends can facilitate planning of post-acute care services to meet heightened demand. Population-level data may be particularly useful for examining long-term outcomes requiring longitudinal follow-up. Studies using population-level data have documented an increased risk of long-term mortality, a transient increase in risk of psychiatric diagnoses and psychoactive medication prescriptions, and an increased need for subsequent healthcare utilization after episodes of prolonged mechanical ventilation [9–11]. Furthermore, outcome-focused studies have been used to identify patient populations where use of mechanical ventilation may be of limited benefit. A national study from Taiwan of patients with cancer who underwent prolonged mechanical ventilation demonstrated that 1-year mortality was 85.7%, and that patients with liver, lung or metastatic cancer had the worst
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