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. 2022 Jan 10;26(1):18.
doi: 10.1186/s13054-021-03882-1.

Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study

Jessica González  1   2   3   4 , Iván D Benítez  2   3   4 , David de Gonzalo-Calvo  2   3   4 , Gerard Torres  1   2   3   4 , Jordi de Batlle  2   3   4 , Silvia Gómez  1   2   3   4 , Anna Moncusí-Moix  2   3   4 , Paola Carmona  1   2   3   4 , Sally Santisteve  1   2   3   4 , Aida Monge  1   2   3   4 , Clara Gort-Paniello  2   3   4 , María Zuil  1   2   3   4 , Ramón Cabo-Gambín  1   2   3   4 , Carlos Manzano Senra  1   2   3   4 , José Javier Vengoechea Aragoncillo  1   2   3   4 , Rafaela Vaca  1   2 , Olga Minguez  1   2 , María Aguilar  1   2 , Ricard Ferrer  4   5   6 , Adrián Ceccato  4 , Laia Fernández  4   7 , Ana Motos  4   7 , Jordi Riera  4   5   6 , Rosario Menéndez  4   8 , Darío Garcia-Gasulla  9 , Oscar Peñuelas  4   10 , Gonzalo Labarca  11   12 , Jesús Caballero  13 , Carme Barberà  14 , Antoni Torres  4   7 , Ferran Barbé  15   16   17   18 ; CIBERESUCICOVID Project (COV20/00110, ISCIII)
Collaborators, Affiliations

Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study

Jessica González et al. Crit Care. .

Abstract

Question: We evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae.

Materials and methods: Prospective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge.

Results: We included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29-4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42-4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of - 10.77 (95% CI - 18.40 to - 3.15), with a greater number of affected lobes (+ 1.51 [95% CI 0.89-2.13]) and a greater TSS (+ 4.35 [95% CI 2.41-6.27]) in the chest CT scan.

Conclusions: Among critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up.

Keywords: ARDS; COVID-19; Critically ill patients; Early intubation; Pulmonary sequelae; Respiratory management.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Flow chart of the study. IMV invasive mechanical ventilation
Fig. 2
Fig. 2
In-hospital mortality according to the IMV delay. A Kaplan–Meier curves for in-hospital overall survival. B Additive Cox proportional hazard model with a cubic spline basis to evaluate the association between the time from initial ventilatory support to IMV and in-hospital mortality. EDF effective degrees of freedom, IMV invasive mechanical ventilation
Fig. 3
Fig. 3
Multivariate Cox model with predictors of mortality risk. IMV invasive mechanical ventilation
See this image and copyright information in PMC

Comment in

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