Related Experiment Video

Updated: Jul 25, 2025

Mechanical Ventilation Boot Camp Curriculum

Mechanical Ventilation Boot Camp Curriculum

Published on: March 12, 2018

Association of Hospital Mortality With Initiation of Mechanical Ventilation on a Weekend: A Retrospective Cohort

Karan Rai¹, Ivor S Douglas^2,3, Anuj B Mehta^2,3

¹Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.

Journal of Intensive Care Medicine

|June 26, 2023

Abstract

Rationale:

Increased mortality in patients admitted to hospitals on weekends is a well-described phenomenon labeled the "weekend effect." Studies evaluating the weekend effect in intensive care units (ICUs) have arrived at conflicting results. Identifying a weekend effect for critically-ill patients may inform clinical care pathways and resource allocation.

Objectives:

Determine the association of initiation of mechanical ventilation (MV) upon admission on a weekend versus weekday with hospital mortality.

Methods:

We conducted a retrospective cohort study of non-surgical adult patients using the California Patient Discharge Database from 2018 to 2019. We identified MV initiated on the day of admission and diagnoses using discharge billing codes. The primary exposure was admission and initiation of MV on a weekend versus weekday and the primary outcome was hospital mortality. Hierarchical logistic regression was used to determine the association between hospital mortality and MV initiation timing, adjusting for case-mix.

Results:

Among 90 288 admissions in 2018 and 2019 meeting inclusion criteria, 24 771 (27.5%) had MV initiated on weekends, while 65 517 (72.6%) had MV initiated on weekdays. Patient demographics and comorbidities were similar between groups. Chronic alcohol and substance use disorders, and acute intoxications and traumas were more prevalent among patients with MV initiated on weekends. No difference in hospital mortality was observed with initiation of MV on weekends versus weekdays (23.1% vs 22.8%, ARD = 0.3%, aOR = 1.02, 95% CI 0.98, 1.07).

Conclusions:

Contrary to prior studies, no increased mortality was observed among newly admitted patients initiated on MV on weekends compared to weekdays. While weekend effects may exist in other settings, newly admitted patients likely have MV initiated in the emergency department or ICU, which tend to have more consistent staffing levels. Further research is needed to determine if care patterns in these units could be used as a model for units where weekend effects continue to impact outcomes.

Insights

This study found no increased hospital mortality for critically-ill patients receiving mechanical ventilation (MV) initiated on weekends versus weekdays. These findings suggest consistent staffing in emergency departments and ICUs may mitigate the weekend effect for these patients.

Area of Science:

Critical Care Medicine
Health Services Research
Epidemiology

Background:

The
weekend effect,
an observed increase in hospital mortality for patients admitted on weekends, is well-documented but yields conflicting results in intensive care unit (ICU) settings.
Investigating this phenomenon in critically-ill patients is crucial for optimizing clinical care and resource allocation.

Purpose of the Study:

To determine if initiating mechanical ventilation (MV) on a weekend versus a weekday upon hospital admission is associated with differences in hospital mortality.

Main Methods:

A retrospective cohort study analyzed non-surgical adult patients from the California Patient Discharge Database (2018-2019).
Mechanical ventilation (MV) initiation timing (weekend vs. weekday) on admission was identified, along with diagnoses via billing codes.
Hierarchical logistic regression adjusted for case-mix to assess the association between MV initiation timing and hospital mortality.

Main Results:

The study included 90,288 admissions, with 27.5% having MV initiated on weekends.
Demographics and comorbidities were similar between weekend and weekday MV initiation groups, though substance use and trauma were more prevalent in the weekend group.
No significant difference in hospital mortality was observed between patients initiated on MV on weekends (23.1%) versus weekdays (22.8%).

Conclusions:

Contrary to some prior research, this study found no increased hospital mortality associated with initiating mechanical ventilation on weekends for newly admitted patients.
The consistent staffing typically found in emergency departments and ICUs may explain the absence of a weekend effect in this patient population.
Further research could explore if the care models in these units can be applied to other hospital areas experiencing weekend outcome disparities.

Read full analysis

Keywords:

ICU intubation mechanical ventilation mortality weekend effect

More Related Videos

Author Spotlight: Unraveling the Impact of Mechanical Ventilation on Diaphragm Function and Patient Outcomes

Author Spotlight: Unraveling the Impact of Mechanical Ventilation on Diaphragm Function and Patient Outcomes

Published on: November 3, 2023

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Published on: June 12, 2021

Related Concept Videos

Mechanical Ventilation I: Indication and Settings

Mechanical Ventilation I: Indication and Settings

Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can...

Mechanical Ventilation II: Invasive Ventilation

Mechanical Ventilation II: Invasive Ventilation

Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...

Mechanical Ventilation III: Noninvasive Ventilation

Mechanical Ventilation III: Noninvasive Ventilation

Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let's explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation...

Assessment of Ventilation I: Respiratory Rate

Assessment of Ventilation I: Respiratory Rate

Assessment of Ventilation
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:

Acute Respiratory Failure-V

Acute Respiratory Failure-V

The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...

Ventilatory Modes

Ventilatory Modes

Mechanical ventilators are life-saving devices that support or replace spontaneous breathing. They deliver breaths to patients through varying methods known as ventilator modes. Understanding these modes is critical for healthcare providers managing patients with respiratory failure.
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...

Articles linked to this work by shared authors, journal, and citation graph.

Do-not-resuscitate status and regional analgesia utilization for fracture pain: a comfort paradox?

Regional anesthesia and pain medicine·2026

The ARDS, Pneumonia, and Sepsis Consortium: Rationale, Design, and Feasibility of a National Platform for Phenotyping Critical Illness Syndromes.

Chest·2026

A Novel Medicare Claims-Based Approach to Identifying Tele-ICU Capability and Utilization Across US Hospitals.

Medical care·2026

Effects of an early restrictive versus liberal fluid strategy on long-term patient-centered outcomes in sepsis-induced hypotension: an open-label, randomized controlled trial.

American journal of respiratory and critical care medicine·2026

Drivers of Increased Hospital Mortality for Non-COVID-19 Conditions During COVID-19 Surges in 2020.

Journal of patient safety·2026

Association of primary spoken language and noninvasive ventilation failure in hospitalized adults.

Journal of critical care·2026

See all related articles