To the Editor The study by Dr Valley and colleagues1 on the association between intensive care unit (ICU) admission and mortality among Medicare beneficiaries hospitalized with pneumonia addresses a topic with potentially important implications for clinical practice and public policy. Further evaluation could yield more robust and targeted results.
First, early institution of noninvasive ventilation may improve outcomes after mild respiratory failure in some patients,2 and it is commonly managed outside ICUs. The code for continuous positive airway pressure (CPAP) could identify a subpopulation that derived benefit from noninvasive support. Thus, the analysis should adjust for the capability of general wards to provide noninvasive ventilation.
Zadra AR, Barzaghi N, Di Novi C. Intensive Care Unit Admission and Mortality Among Medicare Beneficiaries With Pneumonia. JAMA. 2016;315(12):1284-1285. doi:10.1001/jama.2015.18020