ArticleThe Lancet regional health. Western Pacific2021
Intensive care unit versus high-dependency care unit for mechanically ventilated patients with pneumonia: a nationwide comparative effectiveness study.
Article in The Lancet regional health. Western Pacific, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
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Who cites it
24 citing papers in PubMed, 42 citations in OpenAlex.
- Critical care access and outcomes in residents of inpatient-care catchment areas with and without ICUs: a nationwide cohort study in Japan.The Lancet regional health. Western Pacific · 2026Article
- Nationwide Comparison of ICU Procedure Frequencies in Japan Using a Public Open Database: A Cross-Sectional Study by ICU Admission Fee Type and Region.Journal of clinical medicine · 2026Article
- National cost of intensive care in Japan from 2018 to 2022.Journal of intensive care · 2026Article
- Intensive Care Unit versus High-Dependency Care Unit for Patients with Sepsis-Associated Acute Kidney Injury Requiring Continuous Kidney Replacement Therapy: An Observational Nationwide Database Study.Blood purification · 2026Observational
- In-hospital mortality of patients admitted to the intermediate care unit in hospitals with and without an intensive care unit: a nationwide inpatient database study.Critical care (London, England) · 2025Article
- The Role of Intermediate Care in Supporting Critically Ill Patients and Critical Care Infrastructure.Critical care clinics · 2024Review
- Hospital and regional variations in intensive care unit admission for patients with invasive mechanical ventilation.Journal of intensive care · 2024Article
- EPidemiology, clinical characteristics and Outcomes of 4546 adult admissions to high-dependency and intensive care units in Kenya (EPOK): a multicentre registry-based observational study.Critical care explorations · 2024Article
- Association between regional critical care capacity and the incidence of invasive mechanical ventilation for coronavirus disease 2019: a population-based cohort study.Journal of intensive care · 2024Article
- Article
- Where internal medical patients receive intensive interventions: results from a tertiary-care hospital in Israel.Israel journal of health policy research · 2023Observational
- Artificial cerebrospinal fluid use during burr-hole surgery and reoperation rate in patients with chronic subdural hematoma: an analysis using a nationwide inpatient database.Acta neurochirurgica · 2023Article
- An evaluation of the impact of the implementation of the Tele-ICU: a retrospective observational study.Journal of intensive care · 2023Article
- Mortality analysis among sepsis patients in and out of intensive care units using the Japanese nationwide medical claims database: a study by the Japan Sepsis Alliance study group.Journal of intensive care · 2023Article
- Intensive Care Unit versus High-dependency Care Unit for COVID-19 Patients with Invasive Mechanical Ventilation.Annals of the American Thoracic Society · 2023Observational
- Impact of the COVID-19 pandemic on critical care utilization in Japan: a nationwide inpatient database study.Journal of intensive care · 2022Article
- Diagnosis, severity stratification and management of adult acute pancreatitis-current evidence and controversies.World journal of gastrointestinal surgery · 2022Review
- Association Between Intensive Care Unit Admission Practices and Outcomes in Patients with Isolated Traumatic Subarachnoid Hemorrhage: A Nationwide Inpatient Database Analysis in Japan.Neurocritical care · 2022Observational
- Outcomes in Temporary ICUs Versus Conventional ICUs: An Observational Cohort of Mechanically Ventilated Patients With COVID-19-Induced Acute Respiratory Distress Syndrome.Critical care explorations · 2022Article
- Premorbid Clinical Frailty Score and 30-day mortality among older adults in the emergency department.Journal of the American College of Emergency Physicians open · 2022Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMany mechanically ventilated patients in Japan are treated in high-dependency care units (HDUs) rather than intensive care units (ICUs). HDUs can provide intermediate-level care with reduced costs; however, there is limited evidence on whether mechanically ventilated patients should be treated in the ICU or HDU.
methodsThis was a comparative effectiveness study using a nationwide administrative database in Japan. We identified mechanically ventilated patients with pneumonia in ICU or HDU on the day of admission in the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2019. The primary outcome was 30-day in-hospital mortality. Propensity score matching analysis was performed to compare this outcome between patients treated in the ICU and HDU. The robustness of the analyses was evaluated with multivariable regression, overlap weighting, and instrumental variable analyses.
findingsOf 14,859 mechanically ventilated patients with pneumonia, 7,528 (51%) were treated in the ICU and 7,331 (49%) were treated in the HDU. After propensity score matching, patients treated in the ICU had significantly lower 30-day in-hospital mortality than did those treated in the HDU (24.0% vs. 31.2%; difference, -7.2%; 95% confidence interval, -10.0% to -4.4%). The multivariable regression, overlap weighting, and instrumental variable analyses showed a similar direction and magnitude of association.
interpretationCritical care for mechanically ventilated patients with pneumonia in the ICU was associated with a 7.2% decrease in 30-day in-hospital mortality vs. care in the HDU. Residual confounding may still play a role in the effect estimates.
fundingThis study received funding from Ministry of Health, Labour and Welfare, Japan, and Ministry of Education, Culture, Sports, Science and Technology, Japan.
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