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Clinical Trial
. 2023 Apr 27;23(1):140.
doi: 10.1186/s12871-023-02081-5.

Timing of intubation and ICU mortality in COVID-19 patients: a retrospective analysis of 4198 critically ill patients during the first and second waves

Sara Manrique #  1   2 , Laura Claverias #  3 , Mónica Magret  3   4 , Joan Ramón Masclans  5 , María Bodi  3   4 , Sandra Trefler  3   4 , Laura Canadell  4   6 , Emili Díaz  7 , Jordi Sole-Violan  8   9 , Elena Bisbal-Andrés  10 , Ruth González Natera  11 , Antonio Albaya Moreno  12 , Montserrat Vallverdu  13 , Juan Carlos Ballesteros  14 , Lorenzo Socias  15 , Federico Gordo Vidal  16 , Susana Sancho  17 , Ignacio Martin-Loeches  18 , Alejandro Rodriguez  3   4
Affiliations
Clinical Trial

Timing of intubation and ICU mortality in COVID-19 patients: a retrospective analysis of 4198 critically ill patients during the first and second waves

Sara Manrique et al. BMC Anesthesiol. .

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).

Keywords: COVID-19 pneumonia; Mechanical ventilation; SARS-COV2; Timing to intubation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study. ICU: Intensive Care Unit, IMV= Invasive mechanical ventilation, OTI= Orothraqueal intubation
Fig. 2
Fig. 2
Variables associated with mortality. OR= Odds ratio, SOFA= Sequential Organ Failure Assessment, APACHE= Physiology and Chronic Health Evaluation, PaO2/FiO2 (arterial oxygen pressure/ inspired oxygen fraction), LDH: lactate dehydrogenase
Fig. 3
Fig. 3
Cox regression ICU mortality
See this image and copyright information in PMC

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