Ventilatory strategies in intensive care: Balancing clinical outcomes and cost-effectiveness

Abstract

Ventilatory strategies shape both outcomes and healthcare expenditures in acute respiratory failure. In resource-limited settings, choosing interventions that provide the greatest value is crucial. Evidence from India indicates that non-invasive ventilation may reduce mortality, intensive care unit stay, and treatment costs to nearly one-fifth of those associated with invasive mechanical ventilation. Comparative data from other low-income and middle-income countries reinforce the importance of prioritizing scalable, protocolized strategies with favorable cost-effectiveness profiles. This editorial discusses why economic considerations are indispensable in critical care, highlights key limitations in available studies, and emphasizes that the value of ventilatory support depends heavily on context - particularly pricing, capacity constraints, and local willingness-to-pay thresholds. Strengthening multicenter economic research, especially in low-income and middle-income countries, is vital to guide policy decisions and ensure equitable, sustainable deployment of ventilatory technologies.

Keywords: Artificial respiration; Intensive care units; Cost-benefit analysis; Respiratory insufficiency; Ventilatory strategies

Core Tip: Cost-effectiveness analysis of ventilatory strategies in intensive care helps balance optimal patient outcomes with rational resource use. Evidence supports the value of lung-protective ventilation, non-invasive ventilation, and prone positioning in improving survival at relatively low cost. In contrast, prolonged mechanical ventilation is resource-intensive, offering limited incremental benefit and highlighting the need for targeted, efficient critical care interventions.