生命維持装置の使用と集中治療室に入院した患者の結果
Emily E Moin1,2, Nicholas J Seewald3, Scott D Halpern1,2,3
1Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia.
JAMA
|April 14, 2025
まとめ
米国では,COVID-19のパンデミック期間中に死亡率と入院期間が増加し,それ以降は基本状態に戻りました. 機械呼吸器の使用は減少し,重症治療室 (ICU) で血管圧縮器の使用は増加しました.
科学分野:
- クリティカル ケア 医療
- 流行病学
- 医療サービス研究
背景:
- 過去10年間で集中治療室 (ICU) のアウトカムと生命維持装置の利用に関する全国的なデータは限られており,進化する重症治療法の理解を妨げています.
- COVID-19 パンデミックは医療システムに重大な影響を及ぼし,米国における重症治療の流行病学への影響の検討が必要となった.
研究 の 目的:
- COVID-19 パンデミックの前,中,後の期間の米国集中治療室 (ICU) の重症治療の流行病学を特徴づける.
- ICU 患者の人口統計,死亡率,滞在期間,および生命維持介入の使用の動向を分析する.
主な方法:
- 2014年から2023年まで54の米国保健システムでICUケアを必要とする3,453,687人の成人のデータを分析したコホート研究です.
- データには,患者の人口統計,併発症,疾患の重症度,COVID-19 状態,入院死亡率,ICU 滞在期間,機械呼吸器,血管圧縮器の使用などの結果が含まれていました.
主要な成果:
- 病院での死亡率とICUでの滞在期間,特にCOVID-19陽性患者の場合は,パンデミック期間中に増加したが,2022年半ばまでにパンデミック前ベースラインに戻った.
- 病院での調整された死亡率は,COVID陰性およびCOVID陽性の両方の患者で,このパンデミック中に著しく上昇しました.
- 侵襲的な機械呼吸器の使用率は,流行前のレベルと比較して,流行後減少したが,血管圧縮剤の使用率は7. 2%から21. 6%に大幅に増加した.
結論:
- 住院期間と調整された入院死亡率を含む,米国ICUにおける重症治療の結果は,大抵,パンデミック以前の水準に戻っています.
- 伝染病後の時代に機械呼吸器の使用が減り,血管圧縮剤の投与が増加したことで,生命維持装置の利用に重大な変化が観察されました.
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