Cited by 287Healthcare Operations and Scheduling OptimizationEmergency and Acute Care StudiesRespiratory Support and Mechanisms

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ICU Occupancy and Mechanical Ventilator Use in the United States*

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Wunsch, Hannah, Wagner, Jason, Herlim, Maximilian, Chong, David H., Kramer, Andrew A., Halpern, Scott D.·2013·Critical Care Medicine

DOI 10.1097/ccm.0b013e318298a139PMC PMC3840149

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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.

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Self-citation
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Critical care delivery in the United States: Distribution of services and compliance with Leapfrog recommendations*
Angus, D. C., Shorr, A. F., White, A., Dremsizov, T. T., Schmitz, R. J., & Kelley, M. A. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000206105.05626.15 · Cited by 437
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Assessing contemporary intensive care unit outcome: An updated Mortality Probability Admission Model (MPM0-III)*
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Rationing critical care beds: A systematic review*
Sinuff, T., Kahnamoui, K., Cook, D. J., Luce, J. M., & Levy, M. M. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000130175.38521.9f · Cited by 271
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Wunsch, H., Angus, D. C., Harrison, D. A., Linde‐Zwirble, W. T., & Rowan, K. (2011) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201012-1961oc · Cited by 256
Self-citation
Rationing of Intensive Care Unit Services
Strauss, M. J. (1986) · JAMA · doi:10.1001/jama.255.9.1143 · Cited by 245

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Authors: Wunsch, H., Wagner, J., Herlim, M., Chong, D. H., Kramer, A. A., & Halpern, S. D.
Affiliations: Columbia University (US)
University of Pennsylvania (US)
Leonard Davis Institute of Health Economics (US)
ORCID: Wunsch, Hannah
Wagner, Jason
Chong, David H.
Kramer, Andrew A.
Halpern, Scott D.
Venue: Critical Care Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2013-12
Volume: 41
Issue: 12
Pages: 2712-2719
ISSN: 0090-3493 (ISSN-L)
DOI: 10.1097/ccm.0b013e318298a139
PMC: PMC3840149
OpenAlex: W2050845046
Cited by: 287
References: 36
Citations by year: 2026: 17 · 2025: 27 · 2024: 34 · 2023: 25 · 2022: 24 · 2021: 27 · 2020: 39 · 2019: 24 · 2018: 17 · 2017: 13 · 2016: 11 · 2015: 17 · 2014: 9 · 2013: 1
FWCI: 19.76
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Critical Care Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: Agency for Healthcare Research and Quality (K08HS018406)
National Institute on Aging (K08AG038477)
National Center for Research Resources (UL1RR024156)
Topics: Social Sciences › Decision Sciences › Management Science and Operations Research › Healthcare Operations and Scheduling Optimization
Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Keywords: ICU bed occupancy, mechanical ventilation, intensive care unit, surge capacity, academic vs community hospitals, influenza season, disaster preparedness, project impact, critically ill patients
MeSH terms: Academic Medical Centers, Adult, Aged, Bed Occupancy, Female, Hospitals, Community, Hospitals, Voluntary, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Respiration, Artificial, Retrospective Studies, Time Factors, United States

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