Survival and Healthcare Costs with Invasive Mechanical Ventilation versus Noninvasive Ventilation in Patients with Dementia Admitted with Pneumonia and Respiratory Failure
Bibliographic record
Abstract
Abstract Rationale Invasive mechanical ventilation (IMV) may be burdensome for persons with advanced dementia. Research has shown that IMV use in persons with dementia has increased in the United States, Spain, and Canada. Objectives To compare the outcomes and healthcare costs among hospitalized patients with advanced dementia treated with noninvasive ventilation (NIV) versus IMV. Methods A retrospective cohort study was conducted among hospitalized patients aged 66 years and older with pneumonia, or septicemia with pneumonia, treated with either NIV or IMV between 2015 and 2017. Persons were included if they had Minimum Data Set (MDS) assessments between 1 and 120 days before hospitalization indicating that they had advanced dementia with four or more impairments in activities of daily living. Propensity-matched analysis was performed using clinical information from the MDS, Chronic Condition Warehouse indicators of chronic disease, and prior use measures. Main outcome measures were survival and healthcare costs up to 1 year after discharge. Results Among 27,483 hospitalizations between 2015 and 2017, IMV was used in 12.5% and NIV in 8.2%. A propensity-matched model comparing IMV versus NIV using clinical data from the MDS, Chronic Condition Warehouse indicators of chronic diseases, and prior use revealed matches for 96.3% of hospitalizations with the use of IMV. NIV matched cases had a higher 30-day mortality rate compared with IMV cases (58.7% vs. 51.9%, P ⩽ 0.001), but this survival benefit did not persist, as 1-year mortality was slightly higher among subjects with IMV compared with those with NIV (86.5% vs. 85.9%, P > 0.05). One-year healthcare costs after matching were higher among those treated with IMV compared with NIV (mean, $57,122 vs. $33,696; P < 0.001). Conclusions Among patients with advanced dementia hospitalized with pneumonia or septicemia with pneumonia, improvement in 30-day survival for those treated with IMV compared with NIV must be weighed against lack of 1-year survival benefit and substantially higher costs.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".