Association between regional critical care capacity and the incidence of invasive mechanical ventilation for coronavirus disease 2019: a population-based cohort study.
COVID-19
Critical care capacity
Intensive care unit
Invasive mechanical ventilation
Population study
Journal
Journal of intensive care
ISSN: 2052-0492
Titre abrégé: J Intensive Care
Pays: England
ID NLM: 101627304
Informations de publication
Date de publication:
30 Jan 2024
30 Jan 2024
Historique:
received:
17
11
2023
accepted:
18
01
2024
medline:
30
1
2024
pubmed:
30
1
2024
entrez:
30
1
2024
Statut:
epublish
Résumé
Coronavirus disease 2019 (COVID-19) has exposed critical care supply shortages worldwide. This study aimed to investigate the association between regional critical care capacity and the incidence of invasive mechanical ventilation following novel COVID-19 during the pandemic in Japan, a country with a limited intensive care unit (ICU) bed capacity of a median of 5.1 ICU beds per 100,000 individuals. This population-based cohort study used data from the CRoss Icu Searchable Information System database and publicly available databases provided by the Japanese government and Japanese Society of Intensive Care Medicine. We identified patients recently diagnosed with COVID-19, those who received invasive mechanical ventilation, and those who received extracorporeal membrane oxygenation (ECMO) between February 2020 and March 2023. We analyzed the association between regional critical care capacity (ICU beds, high-dependency care unit (HDU) beds, resource-rich ICU beds, and intensivists) and the incidence of invasive mechanical ventilation, ECMO, and risk-adjusted mortality across 47 Japanese prefectures. Among the approximately 127 million individuals residing in Japan, 33,189,809 were recently diagnosed with COVID-19, with 12,203 and 1,426 COVID-19 patients on invasive mechanical ventilation and ECMO, respectively, during the study period. Prefecture-level linear regression analysis revealed that the addition of ICU beds, resource-rich ICU beds, and intensivists per 100,000 individuals increased the incidence of IMV by 5.37 (95% confidence interval, 1.99-8.76), 7.27 (1.61-12.9), and 13.12 (3.48-22.76), respectively. However, the number of HDU beds per 100,000 individuals was not statistically significantly associated with the incidence of invasive mechanical ventilation. None of the four indicators of regional critical care capacity was statistically significantly associated with the incidence of ECMO and risk-adjusted mortality. The results of prefecture-level analyses demonstrate that increased numbers of ICU beds, resource-rich ICU beds, and intensivists are associated with the incidence of invasive mechanical ventilation among patients recently diagnosed with COVID-19 during the pandemic. These findings have important implications for healthcare policymakers, aiding in efficiently allocating critical care resources during crises, particularly in regions with limited ICU bed capacities. Registry and the registration no. of the study/trial The approval date of the registry was August 20, 2020, and the registration no. of the study was lUMIN000041450.
Sections du résumé
BACKGROUND
BACKGROUND
Coronavirus disease 2019 (COVID-19) has exposed critical care supply shortages worldwide. This study aimed to investigate the association between regional critical care capacity and the incidence of invasive mechanical ventilation following novel COVID-19 during the pandemic in Japan, a country with a limited intensive care unit (ICU) bed capacity of a median of 5.1 ICU beds per 100,000 individuals.
METHODS
METHODS
This population-based cohort study used data from the CRoss Icu Searchable Information System database and publicly available databases provided by the Japanese government and Japanese Society of Intensive Care Medicine. We identified patients recently diagnosed with COVID-19, those who received invasive mechanical ventilation, and those who received extracorporeal membrane oxygenation (ECMO) between February 2020 and March 2023. We analyzed the association between regional critical care capacity (ICU beds, high-dependency care unit (HDU) beds, resource-rich ICU beds, and intensivists) and the incidence of invasive mechanical ventilation, ECMO, and risk-adjusted mortality across 47 Japanese prefectures.
RESULTS
RESULTS
Among the approximately 127 million individuals residing in Japan, 33,189,809 were recently diagnosed with COVID-19, with 12,203 and 1,426 COVID-19 patients on invasive mechanical ventilation and ECMO, respectively, during the study period. Prefecture-level linear regression analysis revealed that the addition of ICU beds, resource-rich ICU beds, and intensivists per 100,000 individuals increased the incidence of IMV by 5.37 (95% confidence interval, 1.99-8.76), 7.27 (1.61-12.9), and 13.12 (3.48-22.76), respectively. However, the number of HDU beds per 100,000 individuals was not statistically significantly associated with the incidence of invasive mechanical ventilation. None of the four indicators of regional critical care capacity was statistically significantly associated with the incidence of ECMO and risk-adjusted mortality.
CONCLUSIONS
CONCLUSIONS
The results of prefecture-level analyses demonstrate that increased numbers of ICU beds, resource-rich ICU beds, and intensivists are associated with the incidence of invasive mechanical ventilation among patients recently diagnosed with COVID-19 during the pandemic. These findings have important implications for healthcare policymakers, aiding in efficiently allocating critical care resources during crises, particularly in regions with limited ICU bed capacities. Registry and the registration no. of the study/trial The approval date of the registry was August 20, 2020, and the registration no. of the study was lUMIN000041450.
Identifiants
pubmed: 38287432
doi: 10.1186/s40560-024-00718-2
pii: 10.1186/s40560-024-00718-2
doi:
Types de publication
Journal Article
Langues
eng
Pagination
6Subventions
Organisme : Japan Agency for Medical Research and Development
ID : JP22fk0108654
Informations de copyright
© 2024. The Author(s).
Références
Nates JL, Nunnally M, Kleinpell R, Blosser S, Goldner J, Birriel B, et al. ICU admission, discharge, and triage guidelines: a framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med. 2016;44:1553–602. https://doi.org/10.1097/CCM.0000000000001856 .
doi: 10.1097/CCM.0000000000001856
pubmed: 27428118
Stretch B, Shepherd SJ. Criteria for intensive care unit admission and severity of illness. Surgery. 2021;39:22–8. https://doi.org/10.1016/j.mpsur.2020.11.004 .
doi: 10.1016/j.mpsur.2020.11.004
Ohbe H, Sasabuchi Y, Yamana H, Matsui H, Yasunaga H. Intensive care unit versus high-dependency care unit for mechanically ventilated patients with pneumonia: a nationwide comparative effectiveness study. Lancet Reg Health West Pac. 2021;13: 100185. https://doi.org/10.1016/j.lanwpc.2021.100185 .
doi: 10.1016/j.lanwpc.2021.100185
pubmed: 34527980
pmcid: 8350066
Ohbe H, Sasabuchi Y, Iwagami M, Ogura T, Ono S, Matsui H, et al. Intensive care unit versus high-dependency care unit for COVID-19 patients with invasive mechanical ventilation. Ann Am Thorac Soc. 2023;20:102–9. https://doi.org/10.1513/AnnalsATS.202206-475OC .
doi: 10.1513/AnnalsATS.202206-475OC
pubmed: 35984418
pmcid: 9819267
Dar M, Swamy L, Gavin D, Theodore A. Mechanical-ventilation supply and options for the COVID-19 pandemic Leveraging all available resources for a limited resource in a crisis. Ann Am Thorac Soc. 2021;18:408–16.
doi: 10.1513/AnnalsATS.202004-317CME
pubmed: 33202144
pmcid: 7919160
Truog RD, Mitchell C, Daley GQ. The toughest triage - allocating ventilators in a pandemic. N Engl J Med. 2020;382:1973–5. https://doi.org/10.1056/NEJMp2005689 .
doi: 10.1056/NEJMp2005689
pubmed: 32202721
Griffin KM, Karas MG, Ivascu NS, Lief L. Hospital preparedness for COVID-19: a practical guide from a critical care perspective. Am J Respir Crit Care Med. 2020;201:1337–44. https://doi.org/10.1164/rccm.202004-1037CP .
doi: 10.1164/rccm.202004-1037CP
pubmed: 32298146
pmcid: 7258631
Kadri SS, Sun J, Lawandi A, Strich JR, Busch LM, Keller M, et al. Association between caseload surge and COVID-19 survival in 558 U.S. hospitals, march to august 2020. Ann Intern Med. 2021;174:1240–51. https://doi.org/10.7326/M21-1213 .
doi: 10.7326/M21-1213
pubmed: 34224257
Critical care statistics. https://www.sccm.org/Communications/Critical-Care-Statistics . Accessed 9 May 2023. In: Society of Critical Care Medicine (SCCM)
Rhodes A, Ferdinande P, Flaatten H, Guidet B, Metnitz PG, Moreno RP. The variability of critical care bed numbers in Europe. Intensive Care Med. 2012;38:1647–53. https://doi.org/10.1007/s00134-012-2627-8 .
doi: 10.1007/s00134-012-2627-8
pubmed: 22777516
Phua J, Faruq MO, Kulkarni AP, Redjeki IS, Detleuxay K, Mendsaikhan N, et al. Critical care bed capacity in Asian countries and regions. Crit Care Med. 2020;48:654–62. https://doi.org/10.1097/CCM.0000000000004222 .
doi: 10.1097/CCM.0000000000004222
pubmed: 31923030
Tu WJ, Liu Y, Zeng X. Critical care capacity during the omicron wave of the COVID-19 pandemic in China: far from enough. Lancet Reg Health West Pac. 2023;31: 100689. https://doi.org/10.1016/j.lanwpc.2023.100689 .
doi: 10.1016/j.lanwpc.2023.100689
pubmed: 36684381
pmcid: 9846919
Ma X, Vervoort D. Critical care capacity during the COVID-19 pandemic: global availability of intensive care beds. J Crit Care. 2020;58:96–7. https://doi.org/10.1016/j.jcrc.2020.04.012 .
doi: 10.1016/j.jcrc.2020.04.012
pubmed: 32408107
pmcid: 7194590
Murthy S, Leligdowicz A, Adhikari NKJ. Intensive care unit capacity in low-income countries: a systematic review. PLoS ONE. 2015;10: e0116949. https://doi.org/10.1371/journal.pone.0116949 .
doi: 10.1371/journal.pone.0116949
pubmed: 25617837
pmcid: 4305307
Turner HC, Van Hao NV, Yacoub S, Hoang VMT, Clifton DA, Thwaites GE, et al. Achieving affordable critical care in low-income and middle-income countries. BMJ Glob Health. 2019;4: e001675. https://doi.org/10.1136/bmjgh-2019-001675 .
doi: 10.1136/bmjgh-2019-001675
pubmed: 31297248
pmcid: 6590958
Salluh JIF, Burghi G, Haniffa R. Intensive care for COVID-19 in low- and middle-income countries: research opportunities and challenges. Intensive Care Med. 2021;47:226–9. https://doi.org/10.1007/s00134-020-06285-y .
doi: 10.1007/s00134-020-06285-y
pubmed: 33184695
Janke AT, Mei H, Rothenberg C, Becher RD, Lin Z, Venkatesh AK. Analysis of hospital resource availability and COVID-19 mortality across the United States. J Hosp Med. 2021;16:211–4.
doi: 10.12788/jhm.3539
pubmed: 33496664
pmcid: 8025594
Gibbons PW, Kim J, Cash RE, He S, Lai D, Christian Renne B, et al. Influence of ICU surge and capacity on COVID mortality across U.S. States and regions during the COVID-19 pandemic. J Intensive Care Med. 2023;38:562–5. https://doi.org/10.1177/08850666231157338 .
doi: 10.1177/08850666231157338
pubmed: 36789759
pmcid: 9936169
Bravata DM, Perkins AJ, Myers LJ, Arling G, Zhang Y, Zillich AJ, et al. Association of intensive care unit patient load and demand with mortality rates in US department of veterans affairs hospitals during the COVID-19 pandemic. JAMA Netw Open. 2021;4: e2034266. https://doi.org/10.1001/jamanetworkopen.2020.34266 .
doi: 10.1001/jamanetworkopen.2020.34266
pubmed: 33464319
pmcid: 7816100
Ogura T, Ohshimo S, Liu K, Iwashita Y, Hashimoto S, Takeda S. Establishment of a disaster management-like system for COVID-19 patients requiring veno-venous extracorporeal membrane oxygenation in Japan. Membranes. 2021. https://doi.org/10.3390/membranes11080625 .
doi: 10.3390/membranes11080625
pubmed: 34436388
pmcid: 8400005
Japan ECM, Onet for COVID-19. Nationwide system to centralize decisions around ECMO use for severe COVID-19 pneumonia in Japan (Special Correspondence). J Intensive Care Med. 2020;8:29.
doi: 10.1186/s40560-020-00445-4
Japan ECM. Mechanical ventilation and extracorporeal membrane oxygenation for acute respiratory failure owing to COVID-19: basic concept. Nihon Shuchu Chiryo Igakukai zasshi. 2020;27:447–52. https://doi.org/10.3918/jsicm.27_447 .
doi: 10.3918/jsicm.27_447
Japan ECM. Onet for COVID- Survey of Critically Ill COVID-19 Patients in Japan, Managed by the Japan ECMOnet for COVID-19. https://crisis.ecmonet.jp/ . Accessed 25 Aug 2023
The Ministry of Health, Labour and Welfare, Japan Visualizing the data: information on COVID-19 infections. https://covid19.mhlw.go.jp/en/ . Accessed 25 Aug 2023
The Ministry of Health, Labour and Welfare, Japan survey of medical institutions. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000055891.html . Accessed 9 May 2023
Statistics Bureau, Ministry of Internal Affairs. Communications result of the population estimates. https://www.stat.go.jp/english/data/jinsui/index.html . Accessed 9 May 2023
The Ministry of Health, Labour and Welfare, Japan Health Center. Real-time information-sharing system on COVID-19 (HER-SYS). https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000121431_00181.html . Accessed 25 Aug 2023
The Japanese Society of Intensive Care Medicine. icu_hcu_beds.pdf. https://www.jsicm.org/news/upload/icu_hcu_beds.pdf . Accessed 25 Aug 2023. In: Number of ICU beds, HDU beds, and intensivists by prefecture; 2021
Ohbe H, Sasabuchi Y, Kumazawa R, Matsui H, Yasunaga H. Intensive care unit occupancy in Japan, 2015–2018: a nationwide inpatient database study. J Epidemiol. 2022;32:535–42. https://doi.org/10.2188/jea.JE20210016 .
doi: 10.2188/jea.JE20210016
pubmed: 33840654
pmcid: 9643790
Prin M, Wunsch H. The role of stepdown beds in hospital care. Am J Respir Crit Care Med. 2014;190:1210–6. https://doi.org/10.1164/rccm.201406-1117PP .
doi: 10.1164/rccm.201406-1117PP
pubmed: 25163008
pmcid: 4315815
Prin M, Harrison D, Rowan K, Wunsch H. Epidemiology of admissions to 11 stand-alone high-dependency care units in the UK. Intensive Care Med. 2015;41:1903–10. https://doi.org/10.1007/s00134-015-4011-y .
doi: 10.1007/s00134-015-4011-y
pubmed: 26359162
Ohbe H, Sasabuchi Y, Matsui H, Fushimi K, Yasunaga H. Resource-rich intensive care units vs standard intensive care units on patient mortality: a nationwide inpatient database study. JMA. 2021;4:397–404. https://doi.org/10.31662/jmaj.2021-0098 .
doi: 10.31662/jmaj.2021-0098
The Ministry of Health, Labour, and Welfare. Japanese Report from the Subcommittee on Countermeasures to Combat New coronavirus infections, https://www.mhlw.go.jp/stf/shingi/shingi-kousei_127717.html . Accessed 12 Dec 2023
Arin P, Minniti M, Murtinu S, Spagnolo N. Inflection points, kinks, and jumps: a statistical approach to detecting nonlinearities. Organ Res Methods. 2022;25:786–814. https://doi.org/10.1177/10944281211058466 .
doi: 10.1177/10944281211058466
Hansen BE. Sample splitting and threshold estimation. Econometrica. 2000;68:575–603. https://doi.org/10.1111/1468-0262.00124 .
doi: 10.1111/1468-0262.00124
StataCorp. Stata Statistical Software: threshold. https://www.stata.com/manuals/tsthreshold.pdf . Accessed 12 Dec 2023. College Station, TX: StataCorp LP
The Ministry of Health, Labour and Welfare, Japan. Statistics of physicians, dentists and pharmacists 2020. https://www.mhlw.go.jp/toukei/saikin/hw/ishi/20/index.html . Accessed 12 Dec 2023
OECD beyond Containment: health systems responses to COVID-19 in the OECD. https://read.oecd-ilibrary.org/view/?ref=119_119689-ud5comtf84&title=Beyond_Containment:Health_systems_responses_to_COVID-19_in_the_OECD . Accessed 9 May 2023
Shime N. Clinical and investigative critical care medicine in Japan. Intensive Care Med. 2016;42:453–5. https://doi.org/10.1007/s00134-015-4165-7 .
doi: 10.1007/s00134-015-4165-7
pubmed: 26762107
Shime N. Resource-rich intensive care units improve health-what is next? JMA. 2022;5:285. https://doi.org/10.31662/jmaj.2021-0229 .
doi: 10.31662/jmaj.2021-0229
Guttormson JL, Calkins K, McAndrew N, Fitzgerald J, Losurdo H, Loonsfoot D. Critical care nurses’ experiences during the COVID-19 pandemic: a US national survey. Am J Crit Care. 2022;31:96–103. https://doi.org/10.4037/ajcc2022312 .
doi: 10.4037/ajcc2022312
pubmed: 34704108
Montgomery CM, Humphreys S, McCulloch C, Docherty AB, Sturdy S, Pattison N. Critical care work during COVID-19: a qualitative study of staff experiences in the UK. BMJ Open. 2021;11: e048124. https://doi.org/10.1136/bmjopen-2020-048124 .
doi: 10.1136/bmjopen-2020-048124
pubmed: 34006556
pmcid: 8137198
Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient hospital mortality. N Engl J Med. 2011;364:1037–45. https://doi.org/10.1056/NEJMsa1001025 .
doi: 10.1056/NEJMsa1001025
pubmed: 21410372
Czapran A, Steel M, Barrett NA. Extra-corporeal membrane oxygenation for severe respiratory failure in the UK. J Intensive Care Soc. 2020;21:247–55. https://doi.org/10.1177/1751143719870082 .
doi: 10.1177/1751143719870082
pubmed: 32782465
Pilishvili T, Gierke R, Fleming-Dutra KE, Farrar JL, Mohr NM, Talan DA, et al. Effectiveness of mRNA Covid-19 vaccine among U.S. health care personnel. N Engl J Med. 2021;385:e90. https://doi.org/10.1056/NEJMoa2106599 .
doi: 10.1056/NEJMoa2106599
pubmed: 34551224
Prime Minister’s Office of Japan COVID-19 vaccines. https://japan.kantei.go.jp/ongoingtopics/vaccine.html . Accessed 25 Aug 2023