近日，美国费城宾夕法尼亚大学Scott D. Halpern团队研究了重症监护病房患者生命支持的使用及其预后。2025年4月14日出版的《美国医学会杂志》发表了这项成果。

在过去10年中，美国全国范围内没有关于重症监护病房（ICU）结果和生命支持使用变化的数据，限制了对实践变化的理解。为了描述新冠疫情大流行之前、期间和之后美国重症监护的流行病学，研究组进行了一项回顾性队列研究，招募因任何原因入住ICU的成年患者，使用2014-2023年期间持续向Epic Cosmos数据库提供数据的54个美国卫生系统的数据。主要结局为未经调整的住院死亡率和根据患者人口统计学、合并症和疾病严重程度调整的住院死亡率；ICU住院时间；并接受生命支持干预，包括机械通气和血管加压药物。

在包括重症监护室护理在内的3453687名入院患者中，中位年龄为65岁（IQR，53-75）。男性占55.3%；17.3%为黑人，6.1%为西班牙裔或拉丁裔；总住院死亡率为10.9%。在疫情期间，肺炎阴性（调整后的比值比[aOR]，1.3[95%CI，1.2-1.3]）和肺炎阳性（aOR，4.3[95%CI，3.8-4.8]）患者的调整后住院死亡率升高，并在2022年年中恢复到基线水平。ICU的中位住院时间为2.1天（IQR，1.1-4.2），在疫情期间，阳性患者的住院时间有所增加（阴性患者的差异为2.0天[95%CI，2.0-2.1]）。在疫情前，侵入性机械通气的发生率为23.2%（95%CI，23.1%-23.2%），在疫情期间增加到25.8%（95%CI，25.8%-25.9%），此后降至疫情前基线以下（22.0%[95%CI，21.9%-22.2%]）。在ICU住院期间，血管升压药的使用率从7.2%增加到21.6%。

研究结果表明，疫情期间美国重症监护室患者的住院时间增加，调整后的住院死亡率恢复到最近的历史基线。现在接受机械通气的患者比疫情前少，而更多的患者服用了升压药。

附：英文原文

Title: Use of Life Support and Outcomes Among Patients Admitted to Intensive Care Units

Author: Emily E. Moin, Nicholas J. Seewald, Scott D. Halpern

Issue&Volume: 2025-04-14

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 3453687 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.

DOI: 10.1001/jama.2025.2163

Source: https://jamanetwork.com/journals/jama/fullarticle/2832708