http://www.ncbi.nlm.nih.gov/pubmed/23963122

Crit Care Med. 2013 Aug 19. [Epub ahead of print]

ICU Occupancy and Mechanical Ventilator Use in the United States.

Wunsch H, Wagner J, Herlim M, Chong DH, Kramer AA, Halpern SD.

Source

1Department of Anesthesiology, Columbia University, New York, NY. 2Department of Epidemiology, Columbia University, New York, NY. 3Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 4Department of Biostatistics & Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 5Department of Medicine, Columbia University, New York, NY. 6Cerner Corporation, Vienna, VA. 7Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 8Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.

Abstract

OBJECTIVES::

Detailed data on occupancy and use of mechanical ventilators in U. S. ICU over time and across unit types are lacking. We sought to describe the hourly bed occupancy and use of ventilators in U.S. ICUs to improve future planning of both the routine and disaster provision of intensive care.

DESIGN::

Retrospective cohort study. We calculated mean hourly bed occupancy in each ICU and hourly bed occupancy for patients on mechanical ventilators. We assessed trends in overall occupancy over the 3 years. We also assessed occupancy and mechanical ventilation rates across different types and sizes of ICUs.

SETTING::

Ninety-seven U.S. ICUs participating in Project IMPACT from 2005 to 2007.

PATIENTS::

A total of 226,942 consecutive admissions to ICUs.

INTERVENTIONS::

None.

MEASUREMENTS AND MAIN RESULTS::

Over the 3 years studied, total ICU occupancy ranged from 57.4% to 82.1% and the number of beds filled with mechanically ventilated patients ranged from 20.7% to 38.9%. There was no change in occupancy across years and no increase in occupancy during influenza seasons. Mean hourly occupancy across ICUs was 68.2% ± 21.3% (SD) and was substantially higher in ICUs with fewer beds (mean, 75.8% ± 16.5% for 5-14 beds vs 60.9% ± 22.1% for 20+ beds, p = 0.001) and in academic hospitals (78.7% ± 15.9% vs 65.3% ± 21.3% for community not-for-profit hospitals, p < 0.001). More than half of ICUs (53.6%) had 4+ beds available more than half the time. The mean percentage of ICU patients receiving mechanical ventilation in any given hour was 39.5% (± 15.2%), and a mean of 29.0% (± 15.9%) of ICU beds were filled with a patient on a ventilator.

CONCLUSIONS::

Occupancy of U.S. ICUs was stable over time, but there is uneven distribution across different types and sizes of units. Only three of 10 beds were filled at any time with mechanically ventilated patients, suggesting substantial surge capacity throughout the system to care for acutely critically ill patients.