PURPOSE: Patients requiring prolonged acute mechanical ventilation (PAMV, MV>96 hours) have hospital survival rates similar to those requiring <96 hours of MV and consume ~2/3rds of hospital resources devoted to MV care. Using 2000-2005 data, we previously estimated that their volume will go from ~250,000 cases in 2000 to 605,898 by year 2020 [Zilberberg MD et al. Crit Care Med 2008;36:1451-55]. With 2006-2008 data becoming available we explored the precision of our previous formulas and estimates.
METHODS: We utilized National Inpatient Sample /Health Care Utilization Project of the Agency for Healthcare Research and Quality data from 2000 to 2008 to calculate historic annual age-adjusted PAMV (ICD-9-CM code 96.72) incidence rates using estimated population statistics from the US 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 US Census Bureau.
RESULTS: Formulas based on the 2000-2005 data predicted the 2008 PAMV volume within a 1.9% margin. The historic annualized rise in adult PAMV increased from 5.0% to 5.2% after incorporating the 2006-2008 data. Factoring in the 2006-2008 data altered our 2020 PAMV estimates from 605,898 (95% confidence interval [CI] 456,695-779,806) to 625,298 (95% CI 552,168-698,838), an upward revision of 3.2%.
CONCLUSIONS: Our original projections for growth of the adult PAMV population in the US hospitals by the year 2020 are altered only slightly by adding the 2006-2008 data. Relatively precise prediction of the 2008 PAMV numbers by the original formulas lends internal validity to the methodology.
CLINICAL IMPLICATIONS: By virtue of being a large, resource-intensive and rapidly increasing population, this group of MV patients requires continued close monitoring over time in order to optimize our preparedness to meet their growing healthcare needs.
DISCLOSURE: The following authors have nothing to disclose: Marya Zilberberg, Marjolein de Wit, Andrew Shorr
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