PURPOSE: Patients requiring prolonged acute mechanical ventilation (PAMV, MV>96 hours) have hospital survival rates similar to those requiring <96 hours of MV1 and consume approximately 2/3rds of the total hospital resources devoted to MV care. Because the composition of the US population is shifting, and because PAMV results in disproportionate resource utilization, we projected the expected volume of adult PAMV cases over the next 4 decades.
METHODS: We utilized the National Inpatient Sample (NIS)/Health Care Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ)2 data from 2000 to 2004 (observation period [OP]) to calculate annual PAMV incidence rate during the OP using estimated population statistics from the US Census Bureau. We fit age-specific linear regression models to the incidence rate changes from the OP, using those to predict future growth by age group. Age-adjusted estimates were computed using population projections obtained from the US Census Bureau.
RESULTS: During the OP annualized increase in PAMV was ∼6%, outpacing growth in all hospital discharges and in US population, ∼1% each. The fastest annualized growth in the incidence of PAMV was observed among 18–44 (8.3%) followed by 45–64 (5.5%) and 65–84 (3.4%) age groups, while the incidence among 85+ age group remained constant. Factoring in both age-specific growth in PAMV population and overall US adult population changes, we project PAMV to more than double by 2020 to nearly 641,511 cases and to more than quintuple from approximately 250,000 cases in 2000 to over 1.4 million annual cases by 2050.
CONCLUSION: PAMV is a large and resource-intensive population whose increase outpaces growth in general US population and in overall hospital volume. Policy makers must factor this explosion in frequency of PAMV into future resource and work force planning.
CLINICAL IMPLICATIONS: Given the resource-intensive nature of these patients, strategies need to be developed to optimize their care and to increase efficiency of healthcare delivery to this large and growing population.1 Zilberberg MD et al. Crit Care Med 2006;34:A1262 http://www.ahrq.gov/HCUPnet/ Accessed March15, 2007.
DISCLOSURE: Marya Zilberberg, None.