Aims The incidence of respiratory failure and use of invasive or non-invasive mechanical ventilation (MV) in the cardiac intensive care units (CICUs) is increasing. While institutional MV volumes are associated with reduced mortality in medical and surgical ICUs, this volume–mortality relationship has not been characterized in the CICU. Methods and results National population-based data were used to identify patients admitted to CICUs (2005–2015) requiring MV in Canada. CICUs were categorized into low (≤100), intermediate (101–300), and high (>300) volume centres based on spline knots identified in the association between annual MV volume and mortality. Outcomes of interest included all-cause in-hospital mortality, the proportion of patients requiring prolonged MV (>96 h) and CICU length of stay (LOS). Among 47 173 CICU admissions requiring MV, 89.5% (42 200) required invasive MV. The median annual CICU MV volume was 43 (inter-hospital range 1–490). Compared to low-volume centres (35.9%), in-hospital mortality was lower in intermediate [29.2%, adjusted odds ratio (aOR) 0.84, 95% confidence interval (CI) 0.72–0.97, P = 0.019] and high-volume (18.2%; aOR 0.82, 95% CI 0.66–1.02, P = 0.076) centres. Prolonged MV was higher in low-volume (29.2%) compared to high-volume (14.8%, aOR 0.70, 95% CI 0.55–0.89, P = 0.003) and intermediate-volume (23.0%, aOR 0.85, 95% CI 0.68–1.06, P = 0.14] centres. Mortality and prolonged MV were lower in percutaneous coronary intervention (PCI)-capable and academic centres, but a shorter CICU LOS was observed only in subgroup of PCI-capable intermediate- and high-volume hospitals. Conclusions In a national dataset, we observed that higher CICU MV volumes were associated with lower incidence of in-hospital mortality, prolonged MV, and CICU LOS. Our data highlight the need for minimum MV volume benchmarks for CICUs caring for patients with respiratory failure.

中文翻译：

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心脏重症监护病房机械通气量与院内死亡率之间的关系

目的 心脏重症监护病房 (CICU) 中呼吸衰竭的发生率以及有创或无创机械通气 (MV) 的使用正在增加。虽然机构 MV 容量与内科和外科 ICU 死亡率降低相关，但这种容量与死亡率之间的关系尚未在 CICU 中得到表征。方法和结果 基于全国人口的数据用于确定加拿大 CICU（2005-2015 年）收治的需要 MV 的患者。根据年度 MV 容量和死亡率之间的关联中确定的样条结，CICU 被分为低容量中心 (≤100)、中容量中心 (101-300) 和高容量中心 (>300)。感兴趣的结果包括全因住院死亡率、需要延长 MV (> 96 小时) 的患者比例和 CICU 住院时间 (LOS)。在 47 173 名需要 MV 入院的 CICU 患者中，89.5%（42 200 名）需要侵入性 MV。CICU 每年 MV 量中位数为 43（医院间范围 1-490）。与低容量中心 (35.9%) 相比，中等容量中心 [29.2%，调整后比值比 (aOR) 0.84，95% 置信区间 (CI) 0.72–0.97，P = 0.019] 和高容量中心的院内死亡率较低（18.2%；aOR 0.82，95% CI 0.66–1.02，P = 0.076）中心。与高容量（14.8%，aOR 0.70，95% CI 0.55–0.89，P = 0.003）和中等容量（23.0%，aOR 0.85，95% CI 0.68）相比，低容量（29.2%）的延长MV更高–1.06，P = 0.14] 中心。具有经皮冠状动脉介入治疗 (PCI) 能力的学术中心的死亡率和延长的 MV 较低​​，但仅在具有 PCI 能力的中型和高容量医院亚组中观察到较短的 CICU LOS。结论 在国家数据集中，我们观察到较高的 CICU MV 容量与较低的院内死亡率、延长的 MV 和 CICU LOS 发生率相关。我们的数据强调了护理呼吸衰竭患者的 CICU 需要制定最低 MV 容量基准。