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. 2020 Sep 2;9(9):2847.
doi: 10.3390/jcm9092847.

Clinical Significance of Timing of Intubation in Critically Ill Patients with COVID-19: A Multi-Center Retrospective Study

Yong Hoon Lee  1 , Keum-Ju Choi  2 , Sun Ha Choi  1 , Shin Yup Lee  1 , Kyung Chan Kim  3 , Eun Jin Kim  3 , Jaehee Lee  1
Affiliations

Clinical Significance of Timing of Intubation in Critically Ill Patients with COVID-19: A Multi-Center Retrospective Study

Yong Hoon Lee et al. J Clin Med. .

Abstract

The effect of intubation timing on the prognosis of critically ill patients with coronavirus 2019 (COVID-19) is not yet well understood. We investigated whether early intubation is associated with the survival of COVID-19 patients with acute respiratory distress syndrome (ARDS). This multicenter, retrospective, observational study was done on 47 adult COVID-19 patients with ARDS who were admitted to the intensive care unit (ICU) in Daegu, Korea between February 17 and April 23, 2020. Clinical characteristics and in-hospital mortality were compared between the early intubation and initially non-intubated groups, and between the early and late intubation groups, respectively. Of the 47 patients studied, 23 (48.9%) were intubated on the day of meeting ARDS criteria (early intubation), while 24 (51.1%) were not initially intubated. Eight patients were never intubated during the in-hospital course. Median follow-up duration was 46 days, and 21 patients (44.7%) died in the hospital. No significant difference in in-hospital mortality rate was noted between the early group and initially non-intubated groups (56.5% vs. 33.3%, p = 0.110). Furthermore, the risk of in-hospital death in the early intubation group was not significantly different compared to the initially non-intubated group on multivariate adjusted analysis (p = 0.385). Results were similar between early and late intubation in the subgroup analysis of 39 patients treated with mechanical ventilation. In conclusion, in this study of critically ill COVID-19 patients with ARDS, early intubation was not associated with improved survival. This result may help in the efficient allocation of limited medical resources, such as ventilators.

Keywords: COVID-19; acute respiratory distress syndrome; intensive care units; intubation; mortality; respiratory failure.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Proportion of intubations implemented among 26 patients who survived after intensive care for COVID-19 with ARDS.
Figure 2
Figure 2
Kaplan–Meier curves showing survival probability during follow-up in patients (A) or in patients treated with MV (B).
Figure 2
Figure 2
Kaplan–Meier curves showing survival probability during follow-up in patients (A) or in patients treated with MV (B).
See this image and copyright information in PMC

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