Author:
Manrique Sara,Claverias Laura,Magret Mónica,Masclans Joan Ramón,Bodi María,Trefler Sandra,Canadell Laura,Díaz Emili,Sole-Violan Jordi,Bisbal-Andrés Elena,Natera Ruth González,Moreno Antonio Albaya,Vallverdu Montserrat,Ballesteros Juan Carlos,Socias Lorenzo,Vidal Federico Gordo,Sancho Susana,Martin-Loeches Ignacio,Rodriguez Alejandro
Abstract
Abstract
Background
The optimal time to intubate patients with SARS-CoV-2 pneumonia has not been adequately determined. While the use of non-invasive respiratory support before invasive mechanical ventilation might cause patient-self-induced lung injury and worsen the prognosis, non-invasive ventilation (NIV) is frequently used to avoid intubation of patients with acute respiratory failure (ARF). We hypothesized that delayed intubation is associated with a high risk of mortality in COVID-19 patients.
Methods
This is a secondary analysis of prospectively collected data from adult patients with ARF due to COVID-19 admitted to 73 intensive care units (ICUs) between February 2020 and March 2021.
Intubation was classified according to the timing of intubation. To assess the relationship between early versus late intubation and mortality, we excluded patients with ICU length of stay (LOS) < 7 days to avoid the immortal time bias and we did a propensity score and a cox regression analysis.
Results
We included 4,198 patients [median age, 63 (54‒71) years; 71% male; median SOFA (Sequential Organ Failure Assessment) score, 4 (3‒7); median APACHE (Acute Physiology and Chronic Health Evaluation) score, 13 (10‒18)], and median PaO2/FiO2 (arterial oxygen pressure/ inspired oxygen fraction), 131 (100‒190)]; intubation was considered very early in 2024 (48%) patients, early in 928 (22%), and late in 441 (10%). ICU mortality was 30% and median ICU stay was 14 (7‒28) days. Mortality was higher in the “late group” than in the “early group” (37 vs. 32%, p < 0.05). The implementation of an early intubation approach was found to be an independent protective risk factor for mortality (HR 0.6; 95%CI 0.5‒0.7).
Conclusions
Early intubation within the first 24 h of ICU admission in patients with COVID-19 pneumonia was found to be an independent protective risk factor of mortality.
Trial registration
The study was registered at Clinical-Trials.gov (NCT04948242) (01/07/2021).
Publisher
Springer Science and Business Media LLC
Subject
Anesthesiology and Pain Medicine
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