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. 2020 Oct 21;2(10):e0254.
doi: 10.1097/CCE.0000000000000254. eCollection 2020 Oct.

Timing of Intubation and In-Hospital Mortality in Patients With Coronavirus Disease 2019

Jaime B Hyman  1 , Evan S Leibner  2   3 , Pranai Tandon  4 , Natalia N Egorova  5 , Adel Bassily-Marcus  2   6 , Roopa Kohli-Seth  2   6 , Varun Arvind  7 , Helena L Chang  5 , Hung-Mo Lin  4   5 , Matthew A Levin  5   8   9
Affiliations

Timing of Intubation and In-Hospital Mortality in Patients With Coronavirus Disease 2019

Jaime B Hyman et al. Crit Care Explor. .

Abstract

Objectives: To examine whether increasing time between admission and intubation was associated with mortality in patients with coronavirus disease 2019 who underwent mechanical ventilation.

Design: Retrospective cohort study of patients with severe acute respiratory syndrome coronavirus 2 infection who were admitted between January 30, 2020, and April 30, 2020, and underwent intubation and mechanical ventilation prior to May 1, 2020. Patients were followed up through August 15, 2020.

Setting: Five hospitals within the Mount Sinai Health System in New York City, NY.

Patients: Adult patients with severe acute respiratory syndrome coronavirus 2 infection who underwent intubation and mechanical ventilation.

Interventions: Tracheal intubation and mechanical ventilation.

Measurements and main results: The primary outcome was in-hospital mortality. A hospital-stratified time-varying Cox model was used to evaluate the effect of time from admission to intubation on in-hospital death. A total of 755 adult patients out of 5,843 admitted with confirmed severe acute respiratory syndrome coronavirus 2 infection underwent tracheal intubation and mechanical ventilation during the study period. The median age of patients was 65 years (interquartile range, 56-72 yr) and 64% were male. As of the time of follow-up, 121 patients (16%) who were intubated and mechanically ventilated had been discharged home, 512 (68%) had died, 113 (15%) had been discharged to a skilled nursing facility, and 9 (1%) remained in the hospital. The median time from admission to intubation was 2.3 days (interquartile range, 0.6-6.3 d). Each additional day between hospital admission and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.03; 95% CI, 1.01-1.05).

Conclusions: Among patients with coronavirus disease 2019 who were intubated and mechanically ventilated, intubation earlier in the course of hospital admission may be associated with improved survival.

Keywords: coronavirus disease 2019 infection; coronavirus disease 2019 pandemic; in-hospital mortality; intubation; mechanical ventilation; respiratory failure.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow chart of patient selection. COVID+ = tested positive for severe acute respiratory syndrome coronavirus 2 infection.
Figure 2.
Figure 2.
Restricted cubic spline plot demonstrating the association between days from admission to intubation and in-hospital mortality.
See this image and copyright information in PMC

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