在重症监护室的患者中使用生命支持和结果
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
概括
美国的重症监护室在COVID-19大流行期间死亡率和停留时间增加,此后恢复到原来的水平. 机械通风的使用减少,而血管压缩器的使用增加在重症监护室 (ICU).
科学领域:
- 危急护理医学
- 流行病学
- 医疗服务研究
背景情况:
- 在过去十年中,全国范围内关于重症监护室 (ICU) 结果和生命支持利用的数据有限,这阻碍了对不断发展的重症监护实践的理解.
- COVID-19 疫情对医疗保健系统产生了重大影响,需要对其对美国重症监护流行病学的影响进行检查.
研究的目的:
- 在COVID-19大流行之前,期间和之后,描述美国重症监护室 (ICU) 关键护理的流行病学.
- 分析ICU患者人口统计,死亡率,停留时间和生命支持干预措施的趋势.
主要方法:
- 一项回顾性队列研究分析了2014年至2023年美国54个卫生系统中需要ICU护理的3,453,687名成年人的数据.
- 数据包括患者人口统计,并发症,疾病严重程度,COVID-19状态,以及住院死亡率,ICU停留时间,机械通风和血管压缩剂使用等结果.
主要成果:
- 在疫情期间,医院内死亡率和ICU停留时间,特别是COVID-19阳性患者的停留时间增加,但到2022年中旬恢复到疫情前的基线.
- 在疫情期间,COVID阴性和COVID阳性患者的住院死亡率显著增加.
- 与疫情前水平相比,侵袭性机械呼吸率在流行后有所下降,而血管压缩剂的使用率从7. 2%大幅增加到21. 6%.
结论:
- 美国ICU的重症护理结果,包括住院时间和调整后的住院死亡率,已基本恢复到大流行前的水平.
- 在流行病后的时代,人们观察到生命支持利用的显著变化,机械通风的使用减少,血管压缩剂的使用增加.
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