title: ICU occupancy and mechanical ventilator use in the United States.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Ninety-seven U.S. ICUs participating in Project IMPACT from 2005 to 2007.
  
  
  METHODS
  A total of 226,942 consecutive admissions to ICUs.
  
  
  METHODS
  None.
  
  
  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.
authors: 1Department of Anesthesiology, Columbia University, New York, NY. 2Department of Epidemiology, Columbia University, New York, NY. 3Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 4Department of Biostatistics & Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 5Department of Medicine, Columbia University, New York, NY. 6Cerner Corporation, Vienna, VA. 7Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 8Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
authors: Hannah
authors: H
authors: Wunsch
authors: Jason
authors: J
authors: Wagner
authors: Maximilian
authors: M
authors: Herlim
authors: David H
authors: DH
authors: Chong
authors: Andrew A
authors: AA
authors: Kramer
authors: Scott D
authors: SD
authors: Halpern
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D001509:Bed Occupancy / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006788:Hospitals, Voluntary / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States
references: Arch Intern Med. 2012 Mar 26;172(6):474-6
references: 22412077
references: Crit Care Med. 2004 Jul;32(7):1588-97
references: 15241106
references: JAMA. 2010 Apr 14;303(14):1371-2
references: 20388892
references: Crit Care Med. 2006 Apr;34(4):958-63; quiz 971
references: 16484912
references: Crit Care Med. 2002 Dec;30(12):2765-70
references: 12483071
references: Anesthesiology. 2004 May;100(5):1271-6
references: 15114227
references: Emerg Med J. 2004 May;21(3):281-5
references: 15107363
references: JAMA. 1986 Mar 7;255(9):1143-6
references: 3945032
references: Am J Respir Crit Care Med. 2011 Jun 15;183(12):1666-73
references: 21471089
references: Arch Intern Med. 2012 Sep 10;172(16):1220-6
references: 22825806
references: Crit Care Med. 2005 Oct;33(10):2393-403
references: 16215397
references: Crit Care Med. 2008 Oct;36(10):2787-93, e1-9
references: 18766102
references: Arch Intern Med. 2012 Mar 26;172(6):467-74
references: 22412076
references: Crit Care Med. 2006 Aug;34(8):2105-12
references: 16755256
references: Med Care. 1983 Apr;21(4):425-34
references: 6843195
references: Lancet. 2006 Dec 23;368(9554):2219-25
references: 17189033
references: Chest. 2009 Mar;135(3):827-833
references: 19265091
references: Curr Opin Crit Care. 2011 Dec;17(6):648-57
references: 21986461
references: N Engl J Med. 1983 Nov 10;309(19):1155-60
references: 6413862
references: Crit Care Med. 2006 Apr;34(4):1016-24
references: 16505703
references: N Engl J Med. 2006 Jul 6;355(1):41-50
references: 16822995
references: Am J Respir Crit Care Med. 2009 Apr 15;179(8):676-83
references: 19201923
references: Am J Respir Crit Care Med. 2012 May 15;185(10):1081-7
references: 22345582
references: Crit Care Med. 2010 Oct;38(10):1947-53
references: 20639743
references: Crit Care Med. 2009 Nov;37(11):2882-7
references: 19866504
references: Crit Care Med. 2007 Mar;35(3):827-35
references: 17255863
references: Chest. 2008 May;133(5 Suppl):8S-17S
references: 18460503
references: Disaster Med Public Health Prep. 2010 Oct;4(3):199-206
references: 21149215
references: J Crit Care. 2010 Jun;25(2):205-13
references: 19682848
references: Chest. 2008 May;133(5 Suppl):51S-66S
references: 18460506
references: Inquiry. 2002-2003 Winter;39(4):400-12
references: 12638714
references: Crit Care Med. 2010 Jan;38(1):65-71
references: 19730257