According to a study in the Journal of Critical Care, overall use of invasive mechanical ventilation increased 73.8% from 1993 to 2009, with a decrease in overall mortality.
However, researchers, who identified 8,309,344 cases of IMV from 1993 to 2009, report that trends in utilization and outcomes of IMV differed markedly based on diagnosis:
- Utilization of IMV for nonsurgical indications increased from 178.9 per 100000 in 1993 to 310.9 per 100000 US adults in 2009.
- Pneumonia cases requiring IMV showed the largest increase (103.6%)
- COPD cases increased by 2.5%
- Heart failure cases decreased by 55.4%.
Similar demographic and clinical changes were observed for pneumonia, COPD, and HF, with cases of IMV becoming younger, more ethnically diverse, and more frequently insured by Medicaid.
In addition, outcome trends for patients differed based on diagnosis, the study found.
Adjusted hospital mortality decreased over time for cases of pneumonia (odds ratio [OR] per 5 years, 0.89) and COPD (OR per 5 years, 0.97) but increased for HF (OR per 5 years, 1.10).
“Unlike favorable outcome trends in pneumonia and COPD, hospital mortality for HF has not improved. Further studies to investigate the outcome gap between HF and other causes of respiratory failure are needed,” the authors wrote.