Background: In most countries, patients receiving mechanical ventilation (MV) are treated in intensive care units\n(ICUs). However, in some countries, including Japan, many patients on MV are not treated in ICUs. There are\ninsufficient epidemiological data on these patients. Here, we sought to describe the epidemiology of patients\non MV in Japan by comparing and contrasting patients on MV treated in ICUs and in non-ICU settings. A\npreliminary comparison of patient outcomes between ICU and non-ICU patients was a secondary objective.\nMethods: Data on adult patients receiving MV for at least 3 days in ICUs or non-ICU settings from April 2010\nthrough March 2012 were obtained from the Quality Indicator/Improvement Project, a voluntary data-administration\nproject covering more than 400 acute-care hospitals in Japan. We excluded patients with cancer-related diagnoses.\nPatient demographic data and the critical care provided were compared between groups.\nResults: Over the study period, 17,775 patients on MV were treated only in non-ICU settings, whereas 20,516 patients\nwere treated at least once in ICUs (46.4% vs. 53.6%). Average age was higher in non-ICU patients than in ICU patients\n(72.8 vs. 70.2, P < 0.001). Mean number of ventilation days was greater in non-ICU patients (11.7 vs. 9.5, P < 0.001).\nHospital mortality was higher in non-ICU patients (41.4% vs. 38.8%, P < 0.001). Standard critical care (e.g., arterial\nline placement, enteral nutrition, and stress-ulcer prevention) was provided significantly less often in non-ICU\npatients. Multivariate analysis showed that ICU admission significantly decreased hospital mortality (adjusted odds\nratio 0.713, 95% CI 0.676 to 0.753).\nConclusions: A large proportion of Japanese patients on MV were treated in non-ICU settings. Analysis of administrative\ndata indicated preliminarily that hospital mortality rates in these patients were higher in non-ICU settings than in ICUs.\nProspective analyses comparing non-ICU and ICU patients on MV by severity scoring are needed.
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