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. 2022 Jan 21;10(2):206.
doi: 10.3390/healthcare10020206.

Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow?

Júlio César Garcia de Alencar  1 , Juliana Martes Sternlicht  1 , Alicia Dudy Muller Veiga  1 , Julio Flávio Meirelles Marchini  1 , Juliana Carvalho Ferreira  2 , Carlos Roberto Ribeiro de Carvalho  2 , Izabel Marcilio  3 , Katia Regina da Silva  4 , Vilson Cobello Junior  5 , Marcelo Consorti Felix  6 , Luz Marina Gomez Gomez  1 , Heraldo Possolo de Souza  1 , Denis Deratani Mauá  7 , Emergency Usp Covid Group  1 , Hcfmusp Covid-Study Group  8
Affiliations

Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow?

Júlio César Garcia de Alencar et al. Healthcare (Basel). .

Abstract

Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients.

Methods: We performed a unicentric retrospective cohort study considering all COVID-19 patients consecutively admitted between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortality.

Results: A total of 592 (20%) patients of 3020 admitted with COVID-19 were intubated during study period, and 310 patients who were intubated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005-1.03).

Conclusion: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality.

Trial registration: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068).

Keywords: COVID-19; SARS-CoV-2; emergency medicine; intubation.

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Conflict of interest statement

The authors declare they have no conflict of interest.

Figures

Figure 1
Figure 1
Study cohort.
Figure 2
Figure 2
Kaplan–Meier survival plot for 28-day mortality in relation to intubation time.
Figure 3
Figure 3
Kaplan–Meier survival plot for 28-day mortality in relation to intubation time after the 4C score at admission adjustments.
See this image and copyright information in PMC

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