Use of Mechanical Ventilation Across 3 Countries

Area of Science:

• Critical Care Medicine
• Health Services Research
• Comparative Effectiveness

Background:

• Invasive mechanical ventilation (IMV) is a critical intervention in intensive care units (ICUs).
• Significant international variation exists in the availability of ICU beds, but data on IMV utilization rates across countries are limited.

Purpose of the Study:

• To compare per capita rates of adult IMV across three high-income nations: England, Canada, and the United States.
• To investigate how IMV rates vary by age and specific comorbidities in these countries.

Main Methods:

• A retrospective cohort study analyzing 2018 data for adult patients (≥20 years) receiving IMV.
• Included patients from England, Canada, and the US, comparing age-standardized IMV and ICU admission rates.
• Rates were stratified by age groups and key diagnoses/comorbidities (e.g., dementia, dialysis dependence).

Main Results:

• The US had the highest age-standardized IMV rate (614 per 100,000 population), followed by Canada (290) and England (131).
• IMV use diverged significantly with age, with the US showing substantially higher rates in adults aged 80+ compared to Canada and England.
• Differences in comorbidities like dementia and dialysis dependence were observed among patients receiving IMV across countries.

Conclusions:

• Significant international disparities exist in adult IMV utilization, with the US employing the resource at a much higher rate than England and Canada.
• Variations in IMV use are particularly pronounced in older populations and may be influenced by patient characteristics and comorbidities.
• These findings underscore the need for further research into patient, clinician, and health system factors driving differential use of this critical, resource-intensive intervention.