{"id":28453,"date":"2025-05-28T04:10:00","date_gmt":"2025-05-27T20:10:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=28453"},"modified":"2025-05-28T05:46:08","modified_gmt":"2025-05-27T21:46:08","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9aicu%e6%94%b6%e6%b2%bb%e6%82%a3%e8%80%85%e4%b8%ad%e7%94%9f%e5%91%bd%e6%94%af%e6%8c%81%e6%b2%bb%e7%96%97%e7%9a%84%e4%bd%bf%e7%94%a8%e4%b8%8e%e7%bb%93","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=28453","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1aICU\u6536\u6cbb\u60a3\u8005\u4e2d\u751f\u547d\u652f\u6301\u6cbb\u7597\u7684\u4f7f\u7528\u4e0e\u7ed3\u5c40"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Caring for the Critically Ill Patient<\/p>\n\n\n\n

April 14, 2025<\/p>\n\n\n\n

Use of Life Support and Outcomes Among Patients Admitted to Intensive Care Units<\/h1>\n\n\n\n

Emily E.\u00a0Moin,\u00a0Nicholas J.\u00a0Seewald,\u00a0Scott D.\u00a0Halpern<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online April 14, 2025. doi:10.1001\/jama.2025.2163<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  How have intensive care unit (ICU) care and outcomes changed in the United States over the past decade?<\/p>\n\n\n\n

Findings<\/strong>  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.<\/p>\n\n\n\n

Meaning<\/strong>  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.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  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.<\/p>\n\n\n\n

Objective<\/strong>  To portray the epidemiology of US critical care before, during, and after the COVID-19 pandemic.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  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.<\/p>\n\n\n\n

Exposures<\/strong>  Patient demographics, COVID-19 status, and pandemic era.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  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.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Of 3\u202f453\u202f687 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.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  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.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Caring for the Critically […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28453"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=28453"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28453\/revisions"}],"predecessor-version":[{"id":28454,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28453\/revisions\/28454"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=28453"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=28453"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=28453"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}