• Kojiro Morita, Hiroki Matsui, Hayato Yamana, Kiyohide Fushimi, Tomoaki Imamura, and Hideo Yasunaga.
• Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Electronic address: kojiromorita-tky@umin.ac.jp.
• J Crit Care. 2017 Oct 1; 41: 209-215.

PurposeLittle is known about the association between advanced practice nursing and mortality. The aim of this study was to evaluate whether the presence of advanced practice nurses (APN), that is, certified nurse (CN) and certified nurse specialist (CNS) in intensive care, is associated with 30-day mortality for mechanically ventilated critically ill patients.Materials And MethodsUsing a Japanese national in-patient database, we identified 45,620 patients who were admitted to an intensive care unit (ICU) and received mechanical ventilation within 2 days of hospital admission between 1 April 2014 and 31 March 2015. We assessed the association between the number of CN/CNSs per 10 adult ICU beds and 30-day mortality.ResultsWe examined 8955 patients in 134 hospitals without CN/CNSs and 36,665 in 284 hospitals with CN/CNSs. Overall, the number of CN/CNSs per 10 adult ICU beds ranged from 0 to 7.5. In the multivariable analysis, the number of CN/CNSs per 10 adult ICU beds was significantly associated with a reduction in 30-day mortality (adjusted odds ratio 0.97; 95% confidence interval, 0.94-1.00; P=0.023).ConclusionsOur findings show that APNs may play an important role in improving patient outcome in the adult ICU.Copyright © 2017 Elsevier Inc. All rights reserved.

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