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

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.

Outcomes of COVID-19 Patients Intubated After Failure of Non-Invasive Ventilation: A Multicenter Observational Study.

“…On the one hand, some authors believe that NIV represents a questionable option and controlled mechanical ventilation should be established as soon as possible because of the risks of patient selfin icted lung injury and delayed intubation (3). On the other hand, solid evidence in favor of early intubation in COVID-19 ARF is still lacking, as several investigations failed to reveal a signi cant difference in mortality according to the time of intubation (4,5).…”

Surgical site infections: guidance for elective surgery during the SARS-CoV-2 pandemic – international recommendations and clinical experience

“…The authors concluded that larger cohort studies were needed to detect a difference in mortality between early and late intubation. Other studies have found no advantage for early or late intubation [ 27 , 30 ]. Current mortality data suggest an advantage for patients in whom intubation is completely avoided, but these data may be confounded.…”

“…Nurses and doctors from other departments had to be recruited to the ICUs and COVID-19 wards; teaching and training had to be implemented and was supported by a continuously updated software programme on the current knowledge of patient care (SOPHIA®, Standard Operating Procedure Healthcare Information Assistant). This became relevant in surgery with respect to differentiating between a surgical site infection (SSI) and COVID-19- infection, and in intensive care for decision of early compared with late intubation in critical respiratory conditions, or the need for tracheostomy [ 27 ]. In the latter, the discussion is ongoing and a clear decision for or against invasive measures is pending [ 28 ].…”

Invasive airway “Intubation” in COVID-19 patients :statistics, causes and recommendations

“…However, it could cause delayed in intubation [33]. It seems that there are no significant differences in mortality rate between the early group and never intubated patients [34].…”