Moin Emily E, Seewald Nicholas J, Halpern Scott D
Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia.
Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia.
JAMA. 2025 Apr 14. doi: 10.1001/jama.2025.2163.
Nationwide data are unavailable regarding changes in intensive care unit (ICU) outcomes and use of life support over the past 10 years, limiting understanding of practice changes.
To portray the epidemiology of US critical care before, during, and after the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of adult patients admitted to an ICU for any reason, using data from the 54 US health systems continuously contributing to the Epic Cosmos database from 2014-2023.
Patient demographics, COVID-19 status, and pandemic era.
In-hospital mortality unadjusted and adjusted for patient demographics, comorbidities, and illness severity; ICU length of stay; and receipt of life-support interventions, including mechanical ventilation and vasopressor medications.
Of 3 453 687 admissions including ICU care, median age was 65 (IQR, 53-75) years. Patients were 55.3% male; 17.3% Black and 6.1% Hispanic or Latino; and overall in-hospital mortality was 10.9%. The adjusted in-hospital mortality was elevated during the pandemic in COVID-negative (adjusted odds ratio [aOR], 1.3 [95% CI, 1.2-1.3]) and COVID-positive (aOR, 4.3 [95% CI, 3.8-4.8]) patients and returned to baseline by mid-2022. The median ICU length of stay was 2.1 (IQR, 1.1-4.2) days, with increases during the pandemic among COVID-positive patients (difference for COVID-positive vs COVID-negative patients, 2.0 days [95% CI, 2.0-2.1]). Rates of invasive mechanical ventilation were 23.2% (95% CI, 23.1%-23.2%) before the pandemic, increased to 25.8% (95% CI, 25.8%-25.9%) during the pandemic, and declined below prepandemic baseline thereafter (22.0% [95% CI, 21.9%-22.2%]). The use of vasopressors increased from 7.2% to 21.6% of ICU stays.
Pandemic-era increases in length of stay and adjusted in-hospital mortality among US ICU patients returned to recent historical baselines. Fewer patients are now receiving mechanical ventilation than prior to the pandemic, while more patients are administered vasopressor medications.
过去10年中，关于重症监护病房（ICU）结局变化和生命支持使用情况的全国性数据并不存在，这限制了对实践变化的理解。
描绘2019冠状病毒病大流行之前、期间和之后美国重症监护的流行病学情况。
设计、设置和参与者：对因任何原因入住ICU的成年患者进行回顾性队列研究，使用2014年至2023年持续向Epic Cosmos数据库提供数据的54个美国医疗系统的数据。
患者人口统计学特征、2019冠状病毒病状态和大流行时代。
未调整以及根据患者人口统计学特征、合并症和疾病严重程度调整后的住院死亡率；ICU住院时间；以及接受生命支持干预的情况，包括机械通气和血管活性药物治疗。
在3453687例接受ICU治疗的入院患者中，中位年龄为65岁（四分位间距，53 - 75岁）。患者中男性占55.3%；黑人占17.3%，西班牙裔或拉丁裔占6.1%；总体住院死亡率为10.9%。在大流行期间，新冠病毒阴性患者（调整后的比值比[aOR]，1.3[95%置信区间，1.2 - 1.3]）和新冠病毒阳性患者（aOR，4.3[95%置信区间，3.8 - 4.8]）的调整后住院死亡率有所升高，并在2022年年中恢复到基线水平。ICU中位住院时间为2.1天（四分位间距，1.1 - 4.2天），在大流行期间，新冠病毒阳性患者的住院时间有所增加（新冠病毒阳性患者与新冠病毒阴性患者的差异为2.0天[95%置信区间，2.0 - 2.1]）。大流行前有创机械通气率为23.2%（95%置信区间，23.1% - 23.2%），大流行期间升至25.8%（95%置信区间，25.8% - 25.9%），此后降至大流行前基线以下（22.0%[95%置信区间，21.9% - 22.2%]）。血管活性药物的使用从ICU住院患者的7.2%增加到21.6%。
大流行时代美国ICU患者住院时间的增加以及调整后的住院死亡率已恢复到近期历史基线水平。与大流行前相比，现在接受机械通气的患者减少，而接受血管活性药物治疗的患者增多。
