Original Investigation
Caring for the Critically Ill Patient
April 14, 2025
Use of Life Support and Outcomes Among Patients Admitted to Intensive Care Units
Emily E. Moin, Nicholas J. Seewald, Scott D. Halpern
JAMA. Published online April 14, 2025. doi:10.1001/jama.2025.2163
Question How have intensive care unit (ICU) care and outcomes changed in the United States over the past decade?
Findings In this nationwide cohort of ICU admissions from 2014-2023, in-hospital mortality and ICU length of stay were stable throughout the 2010s, increased during the COVID-19 pandemic, then returned to prepandemic levels. In-hospital mortality was increased during the pandemic regardless of COVID status. Since 2014, vasopressor use increased 3-fold, while mechanical ventilation rates decreased.
Meaning Following pandemic-era changes, many ICU outcome measures returned to prior levels. The rates of mechanical ventilation have declined even further, while vasopressor use remained significantly elevated above 2010s rates.
Abstract
Importance 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.
Objective 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.
Exposures Patient demographics, COVID-19 status, and pandemic era.
Main Outcomes and Measures 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.
Results 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.
Conclusions and Relevance 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.
