Ohbe Hiroyuki, Hashimoto Satoru, Ogura Takayuki, Nishikimi Mitsuaki, Kudo Daisuke, Shime Nobuaki, Kushimoto Shigeki
Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
J Intensive Care. 2024 Jan 30;12(1):6. doi: 10.1186/s40560-024-00718-2.
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.
2019年冠状病毒病（COVID-19）暴露了全球重症监护物资的短缺。本研究旨在调查在日本这一每10万人中重症监护病房（ICU）床位中位数为5.1张的国家，在新冠疫情期间，地区重症监护能力与新型冠状病毒感染后有创机械通气发生率之间的关联。
这项基于人群的队列研究使用了重症监护病房可搜索信息系统（CRoss Icu Searchable Information System）数据库以及日本政府和日本重症医学学会提供的公开数据库中的数据。我们确定了2020年2月至2023年3月期间最近被诊断为COVID-19的患者、接受有创机械通气的患者以及接受体外膜肺氧合（ECMO）的患者。我们分析了日本47个都道府县的地区重症监护能力（ICU床位、高依赖护理病房（HDU）床位、资源丰富的ICU床位和重症医学专家）与有创机械通气发生率、ECMO发生率以及风险调整死亡率之间的关联。
在居住在日本的约1.27亿人中，有33189809人最近被诊断为COVID-19，在研究期间，分别有12203例和1426例COVID-19患者接受了有创机械通气和ECMO。都道府县层面的线性回归分析显示，每10万人中增加ICU床位、资源丰富的ICU床位和重症医学专家，有创机械通气的发生率分别增加5.37（95%置信区间，1.99 - 8.76）、7.27（1.61 - 12.9）和13.12（3.48 - 22.76）。然而，每10万人中HDU床位的数量与有创机械通气的发生率在统计学上无显著关联。地区重症监护能力的这四个指标均与ECMO发生率和风险调整死亡率在统计学上无显著关联。
都道府县层面的分析结果表明，在疫情期间，增加ICU床位、资源丰富的ICU床位和重症医学专家的数量与最近被诊断为COVID-19的患者中有创机械通气的发生率相关。这些发现对医疗保健政策制定者具有重要意义，有助于在危机期间有效分配重症监护资源，特别是在ICU床位有限的地区。研究注册及注册号 该注册的批准日期为2020年8月20日，研究注册号为lUMIN000041450。
