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Trends in mechanical ventilation use and mortality over time in patients receiving mechanical ventilation in Spain from 2001 to 2015.

Published:December 07, 2019DOI:https://doi.org/10.1016/j.ejim.2019.11.023

      Highlights

      • We examined trends in the incidence and outcomes of 1031,497 patients with ventilator support.
      • The use of non-invasive ventilation (NIV) increased constantly from 2001 to 2015 in Spain.
      • Invasive mechanical ventilation (IMV) increased from 2001 to 2003 and then decreased until 2015.
      • In hospital mortality decreased significantly from 2001 to 2015 in patients who received NIV or IMV.

      Abstract

      Background

      We examined trends in the incidence of ventilator support with noninvasive ventilation (NIV) or invasive mechanical ventilation (IMV) among patients hospitalized in Spain from 2001 to 2015. We also assessed in-hospital mortality (IHM) after receiving these types of ventilator support.

      Methods

      This study was an observational retrospective epidemiological study. Our data source was the Spanish National Hospital Discharge Database.

      Results

      In total, 1,031,497 patients received ventilator support in Spain over the study period. NIV use increased from 18.8 patients per 100.000 inhabitants in 2001 to 108.7 in 2015. IMV utilization increased significantly from 2001 to 2003 and then decreased from 2003 until 2015. Patients who required NIV had the highest mean Charlson Comorbidity Index (CCI) score. Patients who received IMV had the highest in-hospital mortality. Factors associated with an increased risk for IHM were sex, age, conditions included in the CCI (except for COPD and diabetes), haemodialysis, presence of a peripheral arterial catheter, presence of a central venous catheter, readmission and emergency room admission. Undergoing a surgical procedure was a risk factor only for IMV. IHM decreased significantly from 2001 to 2015 in patients who underwent NIV or IMV.

      Conclusions

      We identified an increase in the utilization of NIV over time, whereas use of IMV decreased from 2003 until 2015 after an initial increase from 2001 to 2003. We also found a significant decrease in IHM over time.

      Keywords

      Abbreviations:

      APC (annual percentage rate change), CCI (Charlson comorbidity index), COPD (chronic obstructive pulmonary disease), ER (emergency room), ICD-9-CM (international classification of diseases, ninth revision, clinical modification), ICU (intensive care units), IHM (in-hospital mortality), IMV (invasive mechanical ventilation), LOHS (length of hospital stay), NIV (noninvasive ventilation), SMH (Spanish ministry of health), SNHDD (Spanish national hospital discharge database)
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