Intubation is a costly procedure. It requires admission to the ICU and increases the length of a hospital stay for most patients.
Each year, a quarter (1.1 million) of the 4.4 million people admitted to the ICU in the United States have an acute respiratory failure (ARF). In 2005, the average length of ICU and hospital stay was 14 days for patients with ARF. Total hospital costs for the care of intubated adults was $27 billion, or 12% of all hospital costs in the United States. (1)
Before the coronavirus outbreak, it was estimated that ICU mechanical ventilated patients would increase to 5.5 million in the year 2020, with annual hospital costs over $64 billion. (2)
ICU fixed costs are higher as a result of greater nurse and other personnel staffing and more observation equipment.
Patients using mechanical ventilation have greater variable costs, which include medications, blood products, laboratory tests, and supplies. They also are at higher risk of costly complications, such as ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CLABSI), sepsis and gastrointestinal hemorrhage.
Noninvasive positive pressure ventilation (NIPPV) can be a good alternative to artificial airway and IMV while also minimizing the cost of care for patients without compromising clinical outcomes. Studies show NIPPV reduces the length of hospital stays, reduces the rate of endotracheal intubation and decreases the mortality rate. (3), (4), (5)
NIPPV and effective medical interventions for selected patients will reduce medical costs and improve patient outcomes.
1. Wunsch, H., Linde-Zwirble, W.T., Angus, D.C., et al. (2010). The epidemiology of mechanical ventilation use in the United States. Crit Care Med, 38, 1947–53.
2. Zilberberg, M.D. & Shorr, A.F. (2008). Prolonged acute mechanical ventilation and hospital bed utilization in 2020 in the United States: implications for budgets, plant and personnel planning. BMC Health Serv Res, 8, 242.
3. Keenan, S.P., Sinuff, T., Cook, D.J., & Hill, N.S. (2003). Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med, 138, 861–70.
4. Ferrer, M., Esquinas, A., Leon, M., Gonzalez, G., Alarcon, A., & Torres, A. (2003). Noninvasive ventilation in severe acute hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med, 168(12), 1438-1444.
5. Agarwal, R., Aggarwal, A.N., & Gupta, D. (2006). Is there a role for noninvasive ventilation in acute respiratory distress syndrome? A meta-analysis. Respir Med, 100(12), 2235-2238
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